Atherothrombotic Disease and the Role of Antiplatelet Therapy in Women

BACKGROUND: Atherothrombosis is associated with significant mortality and morbidity in both men and women. Management of this disease, however, is generally guided by evidence from trials conducted predominantly in men, with few studies focused on women alone. Our objective was to review the characteristics and management of atherothrombotic disease in women, with particular emphasis on the therapeutic role of antiplatelet agents. METHODS: Landmark clinical trials and other studies pertaining to atherothrombosis in women (including risk factors, clinical outcomes, and treatment patterns) were obtained through Pubmed and Medline literature research and reviewed. RESULTS: Primary prevention studies indicate a clear benefit of antiplatelet therapy in the reduction of cardiovascular events and, in particular, the risk of stroke in women >or=65 years. In men, this benefit is attributable to a reduction in the risk of myocardial infarction (MI). Combination therapies, including aspirin plus dipyridamole or clopidogrel, effectively reduce the risk of recurrent ischemic events in women. However, the effects are not consistent between men and women across studies. Similarly, gender differences exist in the effect of intravenous glycoprotein IIb/IIIa inhibitors plus aspirin on the risk of death or cardiovascular events. CONCLUSIONS: The effects of antiplatelet therapy regimens differ between men and women. The mechanisms underlying these differences are still to be elucidated; this report highlights the need for more studies focused on women in order to optimize gender-specific therapy and, therefore, improve clinical outcomes in women with atherothrombosis.