Aspirin for the Primary Prevention of Cardiovascular Disease in Women

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 discussed when contemplating the use of aspirin in the primary prevention of cardiovascular disease in women.