Abstract 2455: Cilostazol For Men, But Aspirin For Women In Stroke Prevention For Patients With Cerebral Infarction - Pooled Analysis Of CSPS 2 And CASISP -
Objectives It has been reported that aspirin is effective for primary stroke prevention in women, but not men. Here, we conducted subgroup analysis of pooled results of Cilostazol versus Aspirin for Secondary Ischemic Stroke Prevention [CASISP] in China (Lancet Neurol 7: 494 - 499, 2008) and Cilostazol Stroke Prevention Study 2 [CSPS 2] in Japan (Lancet Neurol 9: 959 - 968, 2010) to evaluate gender differences in the effects of cilostazol and aspirin in secondary stroke prevention.
Methods The analysis included 2410 men (cilostazol 1200, aspirin 1210) and 981 women (cilostazol 497, aspirin 484) from the two independent studies. Incidences of stroke as well as baseline patient characteristics, were compared between men and women in each group. Subgroup analysis, with stroke as an endpoint, was also conducted regarding age (≥60 yrs vs <60 yrs), smoking and drinking habit, complications, stroke subtypes etc. in both genders.
Results At baseline, the rates of patients with smoking and drinking habits and with diabetes mellitus were higher in men versus women, and the rates of older (≥60 yrs) patients and those with hypertension and dyslipidemia were higher in women versus men in both the cilostazol group and aspirin group. However, there was no significant difference in the baseline characteristics of men or of women between the cilostazol and aspirin groups. In men, stroke was significantly reduced by cilostazol versus aspirin (cilostazol 2.89%/person·year, aspirin 4.50%/person·year; p=0.0032). But, in women, aspirin was slightly, though not significantly, more effective than cilostazol (2.40% vs. 2.66%; p=0.7498). Intracranial hemorrhage was also significantly reduced in men by cilostazol versus aspirin (p<0.001, 0.25% vs 1.22%), but not in women (p=0.8813, 0.53% vs 0.48%). Cilostazol was significantly more effective than aspirin in men with older age (≥60 yrs), drinking habit or lacunar infarction. But these differences were not observed in women. Furthermore, hemorrhagic side effects such as gastrointestinal hemorrhage were not different in women in the aspirin group compared with the cilostazol group.
Conclusions Gender differences in efficacy of antiplatelet agents appear to exist for secondary stroke prevention. Cilostazol was more effective in men, but aspirin may be the first choice drug for women.
- © 2012 by American Heart Association, Inc.