Aspirin for the Primary Prevention of Cardiovascular Disease in Women
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Aspirin for the Primary Prevention of Cardiovascular Disease in Women Alison L. Bailey & Charles L. Campbell & Susan S. Smyth
Published online: 9 March 2010 # Springer Science+Business Media, LLC 2010
Abstract Primary prevention of cardiovascular disease, which is the leading cause of death of women in the United States, focuses on treating or eliminating risk factors and often includes the use of aspirin to prevent thrombotic complications of atherosclerosis or atrial fibrillation. Recent evidence reveals sex-based differences in the benefits of aspirin in individuals without established cardiovascular disease. Although use of aspirin does not affect total mortality in either sex, aspirin lowers the risk of ischemic stroke in women and decreases the risk of myocardial infarction in men. Unfortunately, the use of aspirin comes at the expense of an increase in bleeding events, mostly gastrointestinal, that occurs at roughly similar rates in women and men. Aspirin may not be beneficial for primary prevention of cardiovascular events in women with diabetes. The benefits, as well as the risks, of aspirin therapy should be A. L. Bailey (*) Gill Heart Institute and the Division of Cardiovascular Medicine, The University of Kentucky, 900 South Limestone, 326 Wethington Building, Lexington, KY 40536, USA e-mail: [email protected] C. L. Campbell Gill Heart Institute and the Division of Cardiovascular Medicine and Lexington Veteran’s Administration Medical Center, The University of Kentucky, 900 South Limestone, 326 Wethington Building, Lexington, KY 40536, USA e-mail: [email protected] S. S. Smyth Gill Heart Institute and the Division of Cardiovascular Medicine and Lexington Veteran’s Administration Medical Center, The University of Kentucky, 255 BBSRB, Lexington, KY 40536, USA e-mail: [email protected]
discussed when contemplating the use of aspirin in the primary prevention of cardiovascular disease in women. Keywords Aspririn . Primary prevention of cardiovascular disease . Women’s cardiovascular health
Introduction Cardiovascular disease (CVD) is the leading cause of death of women in the United States. In 2005, CVD was the primary cause in 35% of all deaths in women and was listed as primary or contributing cause in 56% of all deaths [1]. The risk of developing CVD increases with age, and by 40 years, the lifetime risk is more than 50% in women. In the past two decades, impressive improvements in the rate of CVD death have occurred in the United States. Despite these advances, statistics in women are still sobering. The death rate from CVD has decreased less in women than in men over the past two decades and is actually increasing among younger women. During this period, when myocardial infarction (MI) prevalence has been decreasing in middle-aged men, a recent analysis of the National Health and Nutrition Examination Surveys (NHANES) data shows a trend toward an increase in the prevalence of MI among similarly aged women [2]. Stroke prevalence has also increased in women during the past two decades. Despite this, the r
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