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To the Editor: In their sex-specific meta-analysis of aspirin in the primary prevention of cardiovascular disease, Dr Berger and colleagues¹ found results similar to the meta-analysis we performed as part of the primary report of the Women's Health Study.² However, meta-analyses can hide important clinical effects—in this case, the evidence of effect modification by age. In the Women's Health Study, the most consistent benefit of aspirin was observed among women aged 65 years or older, a group who comprised only 10% of the study population yet had almost one third of the total cardiovascular events.

This is relevant to any discussion of number needed to treat (NNT) and number needed to harm (NNH). Berger et al compared these measures between all men and all women and found little difference. However, the data in the Women's Health Study allowed age-specific estimates of the 10-year NNT and NNH for low-dose aspirin compared . . . [Full Text of this Article]

Paul M Ridker, MD
pridker@partners.org

Nancy R. Cook, ScD; Julie E Buring, ScD
Brigham and Women's Hospital
Boston, Mass

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