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(Circulation. 2008;117:2844-2846.)
© 2008 American Heart Association, Inc.

Editorial

Aspirin Chemoprevention

One Size Does Not Fit All

Lori Mosca, MD, MPH, PhD

From Columbia University, New York, NY.

Correspondence to Dr Lori Mosca, Professor of Medicine, Director, Preventive Cardiology, New York–Presbyterian Hospital, Columbia University Medical Center, 601 W 168th St, Ste 43, New York, NY 10032. E-mail ljm10@columbia.edu (copy lmr2@columbia.edu).

Key Words: Editorials • aspirin • cardiovascular diseases • cost-benefit analysis • prevention • women

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In 400 BC, Hippocrates prescribed the bark and leaves of the willow tree, which contain salicin, a natural compound similar to aspirin, to relieve pain and fever.¹ In 1948, Dr Lawrence Craven noted that 400 men he prescribed aspirin to had not suffered any heart attacks.¹ Forty years later, the Physician’s Health Study was terminated early because of a significant reduction in the incidence of myocardial infarction (MI) among men randomized to 325 mg aspirin every other day compared with placebo.² Today, aspirin recommendations for chemoprevention of cardiovascular disease (CVD) are incorporated into numerous American Heart Association guidelines (the Table).^3–12 The effectiveness of aspirin prophylaxis for patients with CVD has been well established¹³; however, the clinical utility of aspirin in the primary prevention of CVD has been debated, especially among women.^14,15

View this table:   Table. AHA Guidelines for the Use of Aspirin in CVD Prevention

Article p 2875

In this issue of Circulation, Greving and colleagues,¹⁶ using Markov statistical models with simulated Danish cohorts, show that the cost-effectiveness of aspirin in the primary prevention of CVD varies according to gender, age, and baseline level of CVD risk. A threshold of baseline CVD risk >10% in men and >15% in women was shown to be cost-effective. The gender differential has important clinical implications because most women will not attain this level of CVD risk until their later years, and for many women, the risks of aspirin outweighs the benefits in the setting of primary prevention. The authors showed that costs associated . . . [Full Text of this Article]