No Evidence to Support Routine Use of Aspirin in Most Women for Primary Prevention — Physician’s First Watch
No Evidence to Support Routine Use of Aspirin in Most Women for Primary Prevention
By Larry Husten
In most women, the benefits of regular aspirin use for primary prevention don't outweigh the risks, a Heart study suggests.
In the Women's Health Study, nearly 28,000 women aged 45 and older were randomized to placebo or 100-mg aspirin every other day. Aspirin use led to small reductions in 15-year absolute risks for cardiovascular disease and colorectal cancer; 371 patients need to be treated to prevent one cardiovascular event, and 709 to prevent one colorectal cancer. This small benefit occurred at the expense of an increase in gastrointestinal bleeding — 133 needed to be treated to cause one event.
In women aged 65 or older, aspirin's cardiovascular benefits were more pronounced (number needed to treat, 29). Gastrointestinal bleeding was also increased in this older group, but the CV benefit appeared to outweigh the risk.
The authors conclude that aspirin "is ineffective or harmful in the majority of women with regard to the combined risk of CVD, cancer, and major gastrointestinal bleeding." However, "selective treatment" in older women may be reasonable.