Long-term aromatase-inhibitor therapy in breast cancerTreatment with an aromatase inhibitor for five years as up-front monotherapy or after tamoxifen therapy is the treatment of choice for hormone-receptor-positive early breast cancer in postmenopausal women. This study was designed to evaluate the benefits of extending treatment with letrozole to ten years. 1,918 women were randomised in this double-blind, placebo-controlled trial to receive 2.5 mg of letrozole or placebo for a further five years. The extension of treatment with an adjuvant aromatase inhibitor to 10 years resulted in significantly higher rates of disease-free survival and a lower incidence of contralateral breast cancer than those with placebo. Bone-related toxic effects were more frequently seen in those receiving letrozole. N Engl J Med 2016;375:209-19Migraine and cardiovascular diseaseIs there an association between migraine and risk of cardiovascular disease in women? That is the question addressed in this prospective cohort study which reviews data from US Nurses Health Study. A total of 115,541 women aged 25 to 42 at baseline and free of angina and cardiovascular disease were included. The primary outcome sought was the incidence of major cardiovascular disease. 15.2% of the women had physician-diagnosed migraine. The conclusions reached were that migraine was associated with an approximately 50% increased relative risk of major cardiovascular disease and an approximately 37% increased relative risk of cardiovascular disease mortality. An accompanying review notes the findings and speculates whether treatments decreasing the frequency and severity of the migraine would reduce the cardiovascular outcomes. The question also arisesshould women with migraine be treated with statins or aspirin? BMJ 2016;353:i2610 and BMJ 2016;353:i2806Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic strokeAspirin is recommended for secondary prevention after transient ischaemic attack (TIA) or ischaemic stroke on the basis of trials showing a 13% reduction in long-term risk of recurrent stroke. However, several non-randomised observational studies have reported much higher reduction rates. This meta-analysis was planned to elucidate the issue. The researchers have pooled data for 15,778 participants from 12 trials of aspirin versus control in secondary prevention. They found that the risk of recurrent ischaemic stroke at six weeks was reduced by about 60%. This benefit continued up to 12 weeks but not after 12 weeks. The addition of dipyridamole to the aspirin did not improve results within 12 weeks but did reduce the risk after 12 weeks. The conclusions reached werethat medical treatment substantially reduces the risk of early recurrent stroke after TIA and minor stroke and identify aspirin as the key intervention. The considerable early benefit from aspirin warrants public education about self-administration after possible TIA. Lancet 2016;388:365-75

Long-term aromatase-inhibitor therapy in breast cancerTreatment with an aromatase inhibitor for five years as up-front monotherapy or after tamoxifen therapy is the treatment of choice for hormone-receptor-positive early breast cancer in postmenopausal women. This study was designed to evaluate the benefits of extending treatment with letrozole to ten years. 1,918 women were randomised in this double-blind, placebo-controlled trial to receive 2.5 mg of letrozole or placebo for a further five years. The extension of treatment with an adjuvant aromatase inhibitor to 10 years resulted in significantly higher rates of disease-free survival and a lower incidence of contralateral breast cancer than those with placebo. Bone-related toxic effects were more frequently seen in those receiving letrozole. N Engl J Med 2016;375:209-19Migraine and cardiovascular diseaseIs there an association between migraine and risk of cardiovascular disease in women? That is the question addressed in this prospective cohort study which reviews data from US Nurses Health Study. A total of 115,541 women aged 25 to 42 at baseline and free of angina and cardiovascular disease were included. The primary outcome sought was the incidence of major cardiovascular disease. 15.2% of the women had physician-diagnosed migraine. The conclusions reached were that migraine was associated with an approximately 50% increased relative risk of major cardiovascular disease and an approximately 37% increased relative risk of cardiovascular disease mortality. An accompanying review notes the findings and speculates whether treatments decreasing the frequency and severity of the migraine would reduce the cardiovascular outcomes. The question also arisesshould women with migraine be treated with statins or aspirin? BMJ 2016;353:i2610 and BMJ 2016;353:i2806Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic strokeAspirin is recommended for secondary prevention after transient ischaemic attack (TIA) or ischaemic stroke on the basis of trials showing a 13% reduction in long-term risk of recurrent stroke. However, several non-randomised observational studies have reported much higher reduction rates. This meta-analysis was planned to elucidate the issue. The researchers have pooled data for 15,778 participants from 12 trials of aspirin versus control in secondary prevention. They found that the risk of recurrent ischaemic stroke at six weeks was reduced by about 60%. This benefit continued up to 12 weeks but not after 12 weeks. The addition of dipyridamole to the aspirin did not improve results within 12 weeks but did reduce the risk after 12 weeks. The conclusions reached werethat medical treatment substantially reduces the risk of early recurrent stroke after TIA and minor stroke and identify aspirin as the key intervention. The considerable early benefit from aspirin warrants public education about self-administration after possible TIA. Lancet 2016;388:365-75