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Aspirin for Primary Stroke Prevention; Evidence for a Differential Effect in Men and Women

Zuzana Gdovinova1, Christine Kremer2, Svetlana Lorenzano3

  • 1Neurology Department, Faculty of Medicine P.J. Safarik University Košice, L. Pasteur University Hospital, Košice, Slovakia.

Frontiers in Neurology
|July 8, 2022
PubMed

Insights

Aspirin effectively prevents stroke and ischemic stroke in women but increases bleeding risk. It is not recommended for primary prevention in men or for individuals with covert cerebral small vessel disease.

Area of Science:

  • Cardiovascular Medicine
  • Neurology
  • Preventive Medicine

Background:

  • The role of aspirin in primary prevention of cardiovascular events, particularly stroke, remains debated.
  • Covert cerebral small vessel disease (ccSVD) is a risk factor for stroke, but aspirin's efficacy in this population is unclear.

Purpose of the Study:

  • To evaluate the effectiveness of aspirin in primary stroke prevention for men and women.
  • To assess the impact of aspirin on ischemic stroke risk in patients with ccSVD.

Main Methods:

  • Systematic literature search of PubMed and Cochrane Library databases up to May 2021.
  • Inclusion of 11 randomized controlled trials assessing aspirin for primary cardiovascular prevention.
  • Primary outcomes included incidence of ischemic stroke (IS) and hemorrhagic stroke (HS).

Main Results:

  • Aspirin significantly reduced stroke and IS risk in women (p=0.03 and p=0.008, respectively) without increasing hemorrhagic stroke risk.
  • In men, aspirin showed no significant effect on stroke or IS risk but trended towards increasing hemorrhagic stroke risk (p=0.05).
  • Aspirin use was associated with a significant increase in major bleeding events in both sexes (p < 0.05).

Conclusions:

  • Aspirin is effective for primary stroke and IS prevention in women, with a manageable bleeding risk profile.
  • Aspirin is not recommended for primary stroke prevention in men due to lack of efficacy and potential harm.
  • Current evidence does not support the use of aspirin for stroke prevention in patients with ccSVD.
Abstract

Keywords:
aspirinhemorrhagic strokeischemic strokemenprimary preventionwomen

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