Despite increasing evidence over the past decade documenting that sex and gender frequently

matter in CVD, this study demonstrated that SGBA was rarely considered in systematic reviews.
We suggest this omission has important implications for assuring the quality of research and of
evidence-based policy and practice and for achieving equitable health outcomes for women and
men. To build a robust evidence base for future work in cardiovascular health, we propose that
the methodologies of systematic reviews and of SGBA be refined and synchronized to enhance
the collection, synthesis, and analysis of evidence for decision making.

META-ANALYSIS OF MULTIPLE PRIMARY PREVENTION TRIALS OF

CARDIOVASCULAR EVENTS USING ASPIRIN

Alfred A. Bartolucci PhDa, , , Michal Tendera MDb and George Howard DrPHa
The American Journal of Cardiology. Article in Press (Corrected Proof). Available
online 8 April 2011.
a
Department of Biostatistics, School of Public Health, University of Alabama at Birmingham,
Birmingham, Alabama;b 3rd Division of Cardiology Medical University of Silesia, Katowice,
Poland

Abstract

Several meta-analyses have focused on determination of the effectiveness of aspirin

(acetylsalicylic acid) in primary prevention of cardiovascular (CV) events. Despite these data,
the role of aspirin in primary prevention continues to be investigated. Nine randomized trials
have evaluated the benefits of aspirin for the primary prevention of CV events: the British
Doctors' Trial (BMD), the Physicians' Health Study (PHS), the Thrombosis Prevention Trial
(TPT), the Hypertension Optimal Treatment (HOT) study, the Primary Prevention Project (PPP),
the Women's Health Study (WHS), the Aspirin for Asymptomatic Atherosclerosis Trial (AAAT),
the Prevention of Progression of Arterial Disease and Diabetes (POPADAD) trial, and the
Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) trial. The
combined sample consists of about 90,000 subjects divided approximately evenly between those
taking aspirin and subjects not taking aspirin or taking placebo. A meta-analysis of these 9 trials
assessed 6 CV end points: total coronary heart disease, nonfatal myocardial infarction (MI), total
CV events, stroke, CV mortality, and all-cause mortality. No covariate adjustment was
performed, and appropriate tests for treatment effect, heterogeneity, and study size bias were
applied. The meta-analysis suggested superiority of aspirin for total CV events and nonfatal MI,
(p <0.05 for each), with nonsignificant results for decreased risk for stroke, CV mortality, and
all-cause mortality. There was no evidence of a statistical bias (p >0.05). In conclusion, aspirin
decreased the risk for CV events and nonfatal MI in this large sample. Thus, primary prevention
with aspirin decreased the risk for total CV events and nonfatal MI, but there were no significant
differences in the incidences of stroke, CV mortality, all-cause mortality and total coronary heart
disease.

Sex specific findings: “I like to say you have to make the recommendation about aspirin one
patient at a time,” Dr. Michael L. LeFevre, who was not linked to the study, told Reuters Health.
LeFevre worked on the 2009 aspirin recommendations from the U.S. Preventive Services Task
Force (USPSTF). The task force advises that women age 55 to 79 take aspirin to reduce stroke
risk, as long as the benefit outweighs the risk of bleeding. The study was supported by aspirin-
maker Bayer AG.

Cigarette Smoking Causes More Arterial

Damage in Women than in Men by E
Tremboli et al

Anticoagulants are underused in older

women with AF relative to older men
with AF, despite comparable risk
profiles. Women receiving warfarin have
a significantly higher risk of major
bleeding, suggesting the need for careful
monitoring of anticoagulant intensity in
women. (Circulation.
2001;103:2365-2370.)
 Background—Although sex differences in coronary artery disease have received considerable attention, few
studies have
dealt with sex differences in the most common sustained cardiac arrhythmia, atrial fibrillation (AF). Differences
in presentation and clinical course may dictate different approaches to detection and management. We sought to
examine sex-related differences in presentation, treatment, and outcome in patients presenting with new-
onset AF.
Methods and Results—The Canadian Registry of Atrial Fibrillation (CARAF) enrolled subjects at the time of
first ECG-confirmed diagnosis of AF. Participants were followed at 3 months, at 1 year, and annually thereafter.
Treatment was at the discretion of the patients’ physicians and was not directed by CARAF investigators.
Baseline and follow-up data collection included a detailed medical history, clinical, ECG, and echocardiographic
measures, medication history, and therapeutic interventions. Three hundred thirty-nine women and 560 men
were followed for 4.1461.39 years. Compared with men, women were older at the time of presentation, more
likely to seek medical advice because of symptoms, and experienced significantly higher heart rates during AF.
Compared with older men, older women were half as likely to receive warfarin and twice as likely to receive
acetylsalicylic acid. Compared with men on warfarin, women on warfarin were 3.35 times more likely to
experience a major bleed.
Conclusions—Anticoagulants are underused in older women with AF relative to older men with AF, despite
comparable risk profiles. Women receiving warfarin have a significantly higher risk of major bleeding,
suggesting the need for careful monitoring of anticoagulant intensity in women. (Circulation. 2001;103:2365-
2370.)
Key Words: fibrillation n sex n
anticoagulants