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The influence of gender on the effects of aspirin in preventing myocardial infarction.

Yerman T, Gan WQ, Sin DD - BMC Med (2007)

Bottom Line: There is considerable variation in the effect of aspirin therapy reducing the risk of myocardial infarction (MI).Gender could be a potential explanatory factor for the variability.Overall, compared with placebo, aspirin reduced the risk of non-fatal MI (RR = 0.72, 95% confidence interval (CI) 0.64-0.81, p < 0.001) but not of fatal MI (RR = 0.88, 95% CI 0.75-1.03, p = 0.120).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine (Respiratory Division), University of British Columbia, and The James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, St, Paul's Hospital, Vancouver, British Columbia, Canada. todd.yerman@utoronto.ca

ABSTRACT

Background: There is considerable variation in the effect of aspirin therapy reducing the risk of myocardial infarction (MI). Gender could be a potential explanatory factor for the variability. We conducted a systematic review and meta-analysis to determine whether gender mix might play a role in explaining the large variation of aspirin efficacy across primary and secondary MI prevention trials.

Methods: Randomized placebo-controlled clinical trials that examined the efficacy of aspirin therapy on MI were identified by using the PUBMED database (1966 to October 2006). Weighted linear regression technique was used to determine the relationship between log-transformed relative risk (RR) of MI and the percentage of male participants in each trial. The reciprocal of the standard error of the RR in each trial (1/SE) was used as the weight.

Results: A total of 23 trials (n = 113 494 participants) were identified. Overall, compared with placebo, aspirin reduced the risk of non-fatal MI (RR = 0.72, 95% confidence interval (CI) 0.64-0.81, p < 0.001) but not of fatal MI (RR = 0.88, 95% CI 0.75-1.03, p = 0.120). A total of 27% of the variation in the non-fatal MI results could be accounted for by considering the gender mix of the trials (p = 0.017). Trials that recruited predominantly men demonstrated the largest risk reduction in non-fatal MI (RR = 0.62, 95% CI 0.54-0.71), while trials that contained predominately women failed to demonstrate a significant risk reduction in non-fatal MI (RR = 0.87, 95% CI 0.71-1.06).

Conclusion: Gender accounts for a substantial proportion of the variability in the efficacy of aspirin in reducing MI rates across these trials, and supports the notion that women might be less responsive to aspirin than men.

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The effect of aspirin on the risk for non-fatal myocardial infarction (MI) compared with placebo.
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Figure 2: The effect of aspirin on the risk for non-fatal myocardial infarction (MI) compared with placebo.

Mentions: The main findings of the study are summarized in Table 2. Overall, aspirin significantly reduced the risk of non-fatal MI compared with placebo (RR = 0.72, 95% CI 0.64–0.81, p < 0.001) (Figure 2). There was a trend towards lower fatal MI rates with aspirin (RR = 0.88, 95% CI 0.75–1.03, p = 0.120) (Table 2). Aspirin therapy significantly reduced the combined endpoint of fatal and non-fatal MI (RR = 0.79, 95% CI 0.72–0.87, p < 0.001) (Table 2).


The influence of gender on the effects of aspirin in preventing myocardial infarction.

Yerman T, Gan WQ, Sin DD - BMC Med (2007)

The effect of aspirin on the risk for non-fatal myocardial infarction (MI) compared with placebo.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2131749&req=5

Figure 2: The effect of aspirin on the risk for non-fatal myocardial infarction (MI) compared with placebo.
Mentions: The main findings of the study are summarized in Table 2. Overall, aspirin significantly reduced the risk of non-fatal MI compared with placebo (RR = 0.72, 95% CI 0.64–0.81, p < 0.001) (Figure 2). There was a trend towards lower fatal MI rates with aspirin (RR = 0.88, 95% CI 0.75–1.03, p = 0.120) (Table 2). Aspirin therapy significantly reduced the combined endpoint of fatal and non-fatal MI (RR = 0.79, 95% CI 0.72–0.87, p < 0.001) (Table 2).

Bottom Line: There is considerable variation in the effect of aspirin therapy reducing the risk of myocardial infarction (MI).Gender could be a potential explanatory factor for the variability.Overall, compared with placebo, aspirin reduced the risk of non-fatal MI (RR = 0.72, 95% confidence interval (CI) 0.64-0.81, p < 0.001) but not of fatal MI (RR = 0.88, 95% CI 0.75-1.03, p = 0.120).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine (Respiratory Division), University of British Columbia, and The James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, St, Paul's Hospital, Vancouver, British Columbia, Canada. todd.yerman@utoronto.ca

ABSTRACT

Background: There is considerable variation in the effect of aspirin therapy reducing the risk of myocardial infarction (MI). Gender could be a potential explanatory factor for the variability. We conducted a systematic review and meta-analysis to determine whether gender mix might play a role in explaining the large variation of aspirin efficacy across primary and secondary MI prevention trials.

Methods: Randomized placebo-controlled clinical trials that examined the efficacy of aspirin therapy on MI were identified by using the PUBMED database (1966 to October 2006). Weighted linear regression technique was used to determine the relationship between log-transformed relative risk (RR) of MI and the percentage of male participants in each trial. The reciprocal of the standard error of the RR in each trial (1/SE) was used as the weight.

Results: A total of 23 trials (n = 113 494 participants) were identified. Overall, compared with placebo, aspirin reduced the risk of non-fatal MI (RR = 0.72, 95% confidence interval (CI) 0.64-0.81, p < 0.001) but not of fatal MI (RR = 0.88, 95% CI 0.75-1.03, p = 0.120). A total of 27% of the variation in the non-fatal MI results could be accounted for by considering the gender mix of the trials (p = 0.017). Trials that recruited predominantly men demonstrated the largest risk reduction in non-fatal MI (RR = 0.62, 95% CI 0.54-0.71), while trials that contained predominately women failed to demonstrate a significant risk reduction in non-fatal MI (RR = 0.87, 95% CI 0.71-1.06).

Conclusion: Gender accounts for a substantial proportion of the variability in the efficacy of aspirin in reducing MI rates across these trials, and supports the notion that women might be less responsive to aspirin than men.

Show MeSH
Related in: MedlinePlus