Aspirin Has Benefits for Older Women and Those Who Have Cardiovascular Risk / Heart Disease

Aspirin Has Benefits for Older Women and Those Who Have Cardiovascular Risk / He

Aspirin therapy is often prescribed for people who have had a previous heart attack to prevent a second attack, as well as for those at increased risk for a heart attack or other heart problems. The therapy is aimed at platelets, blood cells that aid in clotting after a wound or cut to the skin. Aspirin inhibits platelets from becoming unusually sticky and forming clumps that can obstruct blood flow and cause a heart attack.

More women than men die of cardiovascular disease each year. Women are six times as likely to die of heart disease as of breast cancer. Heart disease kills more women over 65 than all cancers combined.Women are less likely than men to benefit from hospitals’ quality-improvement measures — and were less likely to get all of the drugs, tests, and counseling about smoking, diet and exercise that have been proven to help heart attack survivors live longer and healthier lives.

The biggest factors that contribute to heart disease are smoking, high blood pressure, high cholesterol, family history and age.Taking an aspirin every day may lower your risk of problems if you have coronary artery disease, a heart attack or angina. Aspirin makes your blood thinner, so it is less likely to make a blood clot.

The routine diagnostic tool – the treadmill stress test -- is not entirely reliable for a man and is even less reliable for a woman. Research studies funded by the National Institutes of Health have demonstrated that the treadmill stress test gives false results in up to 40 per cent of women.

While heart disease is the leading cause of death for women 65 and older, it's the third-leading cause of death for women 25 to 44 and second-leading cause of death for women 45 to 64. All women, of all ages, should take heart disease seriously.2007 guidelines from the American Heart Association urge women to be more aggressive about cutting their heart disease and stroke risks. One of the recommendations is for women over 65 years of age to consider daily aspirin therapy.

The gender differences persisted even when researchers took into account how much heart-related risk individuals faced, and how often they went to the doctor. And large numbers of both men and women hadn't yet made diet or exercise changes, even those at high risk. But the study also finds some good news: Men and women are getting their cholesterol and blood pressure checked at about the same rates.

The aspirin recommendation comes out of the ongoing Women's Health Initiative (WHI) study, the largest study of heart disease risk factors in women. In 2005, the WHI group released a study showing that the most consistent benefit of aspirin for heart attack prevention was observed among women 65 years of age or older. Women in this age group who took aspirin had nearly one-third fewer cardiovascular events (heart attack and stroke) than did women who took a placebo. However, the women taking aspirin had more gastrointestinal bleeding as well.

Women who took low to moderate daily doses of aspirin had a reduced death rate, especially from heart disease, according to decades-long research.

The research, based on data from a major trial that has tracked almost 80,000 women since 1976, found that women who reported using aspirin on a regular basis had a 25 percent lower risk of death from any cause than women who didn't take the drug.

The risk of death from cardiovascular disease was 38 percent lower for aspirin users, and there was also a 12 percent reduction in cancer deaths that took effect after a decade of aspirin use, the researchers found in their report based on the Nurses' Health Study.

The results were published in the March 26 issue of the Archives of Internal Medicine.

However, an accompanying editorial in the journal cautioned that the results were open to debate and far from definitive.

The dissenting editorial, by Dr. John A. Baron of Dartmouth Medical School, was based in large part on results of a different trial, the Women's Health Study, which followed almost 40,000 women for 11 years and found no reduction in overall deaths or cardiovascular mortality associated with aspirin therapy.

Therefore, Baron said, the new findings "cannot overcome the accumulated evidence that aspirin is not particularly effective for the primary prevention of death from cardiovascular disease in women."

"This is a complicated issue," said Dr. Andrew T. Chan, an assistant professor of medicine at the Harvard Medical School, and lead author of the new report. "We understand that aspirin has potential health benefits, but who would aspirin therapy be appropriate for?"

There are "areas of disagreement that need further study" before that question can be answered, Chan said. But there is information from the two large studies and other trials that can help guide women and their physicians, he said.

For starters, some studies suggest that aspirin has benefits for older women and those who have cardiovascular risk factors such as high blood pressure, diabetes, high cholesterol and obesity, Chan said. "Our study and the Women's Heath Study do suggest that there is a potential role of aspirin for women who have subclinical cardiovascular disease," he added.

That statement meshes with prevention guidelines issued in 2004 by the American Heart Association. The guidelines recommend aspirin for women at high risk of heart disease or who already have cardiovascular disease, but they don't apply to women at low risk for the disease. For intermediate-risk women, aspirin can be considered if blood pressure is under control and the benefits are believed to outweigh risks, such as gastrointestinal bleeding.

But the decision to take aspirin, or any other medication, should not be made by an individual alone, Chan said.

"I tell women that, at this point, the decision calls for consultation with a doctor," he said. "Aspirin does have side effects, so it is something that has to be individualized. It would be very naive to recommend that treatment for all women across the board."

The new study included information on 29,000 participants in the Nurses' Health study who took between 1 and 14 standard 325-milligram aspirin tablets a week and 5,002 women who took more than 14 tablets weekly.

The reduction in cancer risk that became evident after 10 years was an intriguing finding, Chan said. The Women's Health Study found no such reduction over a decade, he said.

"One important message is that the study suggests the mechanisms at play for cardiovascular disease and cancer are potentially common," Chan said. "This provides further grounds for research into these mechanisms."

Dr. Jeffrey Berger, a cardiology fellow at Duke University who has done related research, said the new report describes "another very large study that tells us individuals who take aspirin live longer. You can't argue with that. We can't prove cause-and-effect, but we can say that when you take aspirin, there is a reduction in overall deaths."

It's important to remember that aspirin has benefits for both men and women, Berger added. "How it benefits men, how it benefits women, that is an important issue at this time," he said.

And anyone who is thinking about daily aspirin "should really talk with doctors about the benefits and risks," Berger said.

The message is clear, but not enough women heed it: Taking an aspirin a day can help prevent heart attacks and stroke in some women, and even prevent further problems if you already have cardiovascular disease.

But it's not a one-size-fits-all prescription. Whether you should -- or shouldn't -- take a daily aspirin depends on a number of factors, including your age and your risk factors for heart disease and stroke, such as high cholesterol levels or diabetes.

However,a new study finds that two in three people with high cholesterol who take aspirin to reduce their risk of heart attack may not be protected.So,patients who respond poorly to the usual dosage of aspirin may need higher doses, whether they should take alternative antiplatelet agents or make further reductions in their total cholesterol and LDL cholesterol so that the aspirin may protect them.


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