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Many women should take aspirin for cardiovascular protection: regular aspirin use helps prevent a second heart attack or stroke but increases bleeding risks. Weigh the pros and cons of aspirin use with your doctor.

Taking a daily aspirin used to be routine for many people aiming to cut their cardiovascular risks; then, studies revealed that regular aspirin use posed a significant risk of gastrointestinal bleeding, which caused many people to rethink their aspirin use. But it appears the aspirin pendulum may have swung too far in the other direction: A study published earlier this year found that fewer than half of women for whom aspirin is recommended actually took a daily aspirin (Journal of Women's Health, April 2012).


"Studies regarding the role of aspirin in preventing cardiovascular disease have focused on two areas: primary prevention and secondary prevention," says Danielle Nicolo, MD, PhD, a cardiologist at the Iris Cantor Health Center at Weill Cornell Medical College. "Primary prevention means preventing the disease before it occurs. Secondary prevention means preventing the progression of the disease after it has been detected."

According to Dr. Nicolo, the benefits of aspirin are evident in patients who have a history of stroke or heart attack: Aspirin use in secondary prevention has been clearly shown to prevent the progression of cardiovascular disease, and is generally recommended for women with known cardiovascular disease and no contraindications.

Women and aspirin

"The use of aspirin as primary prevention against cardiovascular disease has been more controversial, particularly in women, on whom there have been few studies; most of the current guidelines stem from the results of clinical trials of men," Dr. Nicolo notes.

The current data do not support the routine use of aspirin in women younger than age 65 for the prevention of cardiovascular disease unless they are at elevated risk, Dr. Nicolo says. Some of the major risk factors linked to cardiovascular disease include:

* Older age

* High blood pressure

* Diabetes

* Obesity

* Elevated total and LDL cholesterol

* Smoking

* Physical inactivity

Overall, knowing what factors increase the risk of cardiovascular events, such as heart attack and stroke, and modifying the controllable factors, is the most important step in prevention.

Risks vs, benefits

Daily aspirin use can increase the risk of stomach or intestinal bleeding, cause ulcers, and increase the risk of hemorrhagic or bleeding strokes. The risk of bleeding is mostly determined by age, concurrent medical conditions, and current medical therapies. "It is important to note that many prescription and over-the-counter medications can interact with aspirin and increase the risk of bleeding," warns Dr. Nicolo. Two examples are warfarin (Coumadin) and ibuprofen.

Aspirin dosage also remains an important factor in determining the risk of bleeding. Higher doses of aspirin can cause more bleeding than lower doses; there are very few conditions that require long-term treatment with high-dose aspirin. The latest research indicates that low-dose aspirin reduces the risk of cardiovascular disease for women at high risk and for those over 65 years of age. Generally, women at risk of cardiovascular events are advised to take either one baby aspirin (81 mg) every day, or one regular aspirin (325 mg) every other day.

"In summary, it is essential to consult with your doctor to identify your risk factors, review your current medications, and determine whether or not you will benefit from the use of aspirin," advises Dr. Nicol.


The Women's Health Study, a large study of almost 40,000 women, investigated the benefits of aspirin in the primary prevention of cardiovascular disease and suggested that men and women may derive different benefits from aspirin use. The results of the study suggested that aspirin use in women may provide greater protection against stroke than against heart attacks. In contrast, previous studies of aspirin use for primary prevention in men have shown greater protection against heart attacks. These sex-based differences in the primary prevention data were unexpected and require further investigation, researchers say.
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Title Annotation:PREVENTION
Publication:Women's Health Advisor
Date:Dec 1, 2012
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