What to know about aspirin therapy.

Half a century ago, a California general practitioner named Lawrence Craven noticed that none of the 400 men he prescribed aspirin for had suffered heart attacks. Figuring there was some connection, he began recommending an "aspirin a day" for all his patients and colleagues. (13)

Although Dr. Craven's observations occurred in 1948, it took another 54 years of research and data before the idea of aspirin as a heart attack preventative was fully accepted. Today, the American Heart Association and the U.S. Preventive Services Task Force recommend that people at high risk for heart attack or stroke discuss taking a daily, low-dose aspirin with their physicians. (14), (15)

The reality, however, is that women, especially women with diabetes, are much less likely to be on aspirin therapy than men. (16)

"We believe this is related to physicians not recognizing that women are at high risk of cardiovascular disease when, in fact, they are," says Lori Mosca, MD, PhD, director of the preventive-cardiology program at New York-Presbyterian Hospital and the Columbia University Center for Heart Disease Prevention in Manhattan. "We also believe that many physicians don't feel there's as much data on women to support the use of these therapies."

However, Jayne Middlebrooks, MD, an Atlanta cardiologist, says "everyone with diabetes or three or more risk factors for heart disease should consider taking aspirin therapy." Women with diabetes are three to seven times more likely to develop heart disease and have a heart attack, and are at much greater risk of having a stroke than women without diabetes. (17)

While there's no question that women with diabetes should take a daily, low-dose aspirin, a study presented at the American College of Cardiology meeting and published in the New England Journal of Medicine in March found that low-dose aspirin did not appear to prevent first heart attacks in healthy women ages 45 to 65, although it did significantly reduce their risk of ischemic stroke. (18) Of course, check with your healthcare provider before starting or stopping aspirin therapy.

For women who should be on aspirin therapy, it doesn't take much to get the benefits. Studies find that between 75 and 100 milligrams, known as "low-dose aspirin therapy," is enough to reduce the risk for heart attack or angina. (19) Most aspirin brands, including St. Joseph Aspirin and others, come in low-dose formulations of 81 milligrams (mg).

Aspirin is also important if you think you're having a heart attack. First, the American Heart Associations recommends, call 911. Then chew two 81 mg aspirin tablets unless you have any allergies to aspirin or serious bleeding issues. Once you receive medical attention, the aspirin therapy should be continued. Studies find that aspirin taken during a heart attack reduces the risk of death by 23 percent. (20), (21)

Aspirin's cardioprotective benefits stem from its unique ability to make blood cells that are partially responsible for forming clots less sticky. Aspirin also soothes inflammation in the arteries, which helps protect blockages from breaking off. (22)

Aspirin has a downside, however. Because it acts on the overall system that affects bleeding, aspirin also increases the risk of gastrointestinal bleeding, either from an ulcer or gastritis, and the risk of a rare but dangerous form of stroke caused not by a blood clot, but by bleeding in the brain. (23) This fact, and the lack of strong enough evidence to support a change in labeling, led the U.S. Food and Drug Administration panel in December 2003 to vote against including "primary prevention of heart attack" in the indications for use of aspirin on the medication's label. (24)

The message for now: Carry an aspirin with you in case you have a heart attack, and talk to your health care professional about what's best for you in terms of preventing heart disease.

Need more heart health information?

Don't miss Take 10 For Your Heart, a new year-long health campaign from the National Women's Health Resource Center. The campaign offers simple steps to help women Take 10 minutes each day to better understand heart disease and how to improve their heart health. Visit our Web site at www.healthywomen.org for more information.

References

(13) Aspirin History. Bayer. http://www.bayeraspirin.com/press/factsheets/aspirin_history.pdf.

(14) Aspirin for the Primary Prevention of Cardiovascular Events - Chemoprevention. US Preventive Services Task Force. 2002.

(15) AHA Scientific Statement: AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update, #71-0226 Circulation. 2002;106:388-91.

(16) Persell SD, Baker DW. Aspirin use among adults with diabetes: recent trends and emerging sex disparities. Arch Intern Med. 2004 Dec 13-27;164(22):2492-9.

(17) Women, Heart Disease, and Stroke. American Heart Association. http://www.americanheart.org.

(18) Statement from Elizabeth G. Nabel, M.D., Director of the National Heart, Lung, and Blood Institute of the National Institutes of Health on the Findings of the Women's Health Study. [press release]. Washington, DC: National Heart, Lung, and Blood Institute; March 7, 2005.

(19) Peters RJ, Mehta SR, Fox KA, et al. Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) Trial Investigators. Effects of aspirin does when used alone or in combination with Clopidogrel in patients with acute coronary syndromes: observations from the Clopidogrel in unstable angina to prevent recurrent events (CURE) study. Circulation. 2003 Oct 7;108(14):1682-7. Epub 2003 Sep 22.

(20) Gunnar RM, Bourdillon PD, Dison DW, et al. Guidelines for the early management of patients with acute myocardial infarction. A Report of the American College of Cardiology/American Heart Association Task Force Assessment of Diagnostic and Therapeutic Procedures (a subcommittee to develop guidelines for the early management of patients with myocardial infarction). Circulation. 1990;82:664-707.

(21) AHA/ACC Guidelines for Preventing Heart Attack and Death in Patients With Atherosclerotic Cardiovascular Disease: 2001 Update, #71-0214 Circulation. 2001;104:1577-1579.

(22) Scientists Examine Long-Term Risks and Gains of Pain Killers, New York Times. January 22, 2002.

(23) Daily Aspirin Therapy. FDA Consumer magazine. US Food and Drug Administration. September-October 2003. http://www.fda.gov/fdac/features/2003/503_aspirin.html. Accessed January 23, 2005.

(24) Mechcatie E. FDA panel rejects expanded label for aspirin: some support for nonfatal MI indication. OB/GYN News, January 1, 2004.