Is There Still a Role for Aspirin in Primary Prevention in Women in 2020?

Abstract

Aspirin's place in primary prevention for females has not been well delineated and has been under increased scrutiny in light of recent literature and guideline recommendations. The purpose of this review is to discuss current literature reviewing aspirin use for primary prevention in women and to discuss when use is appropriate. The Women's Health Study found no differences in major adverse cardiovascular events (MACE) in women randomized to aspirin vs. placebo, though a significant reduction was observed in women ≥ 65years. More recent literature evaluated outcomes for primary prevention use in patients at increased cardiovascular risk, patients with diabetes, and patients who are elderly. These trials found either no benefit in MACE outcomes or a slight benefit accompanied by an increased risk of bleeding. Furthermore, no difference in outcomes were found in subgroup analyses comparing females receiving aspirin vs. placebo or comparing events in males vs. females. With improvements in risk factor reduction, such as blood pressure control, statin use, diabetes management, and smoking cessation, the role of aspirin for primary prevention in women is still uncertain. Aspirin use for primary prevention in females has failed to show a clear benefit except in women ≥ 65years old, with a potential increase in bleeding events. An effort to better study aspirin in female patients would allow for better identification of women who would or would not benefit from therapy.