Q: When is it a good idea for a woman to take a daily aspirin to
help prevent a heart attack?
Q: When is it a good idea for a woman to take a daily aspirin to help prevent a heart attack?
A: Ever since 1988, when a landmark study led by Harvard researchers found that aspirin helps prevent a first heart attack in men, the question “Does aspirin work for women, too?” has been under investigation. The long-awaited results of a recently published study suggest that the answer is yes – but only for women who are older than 65.
The 10-year study, also led by a team at Harvard, involved almost 40,000 women who were at least 45 years old. Half took a 100-milligram aspirin every other day, while the others took a look-alike dummy pill.
Overall, aspirin had very little effect on the women’s risk of having a heart attack. But when researchers zeroed in on women over age 65, they found that the low-dose aspirin regimen cut heart attack risk and lowered the odds of dying from a heart attack.
When it comes to the heart, aspirin’s magic is in its ability to prevent blood clots. These clumps of red blood cells, platelets, and stringy proteins can block blood vessels feeding the heart. A heart attack occurs when a blood clot lodges in one of these vessels. Yet allowing blood to clot less readily increases bleeding, and so can harm as well as help. Not surprisingly, the women in this study who took aspirin had a slightly higher risk of bleeding in the gut. They were also more prone to nosebleeds, blood in the urine and easy bruising than the women who didn’t take aspirin.
For younger women, these bleeding risks outweigh any possible benefit from preventing blood clots. But for older women, who face a higher risk of heart attack due to their age, aspirin may be a good idea. Low-dose aspirin may also be appropriate for women who already have heart disease, regardless of their age. Women who have diabetes and one other risk factor for heart disease, such as high blood pressure or high cholesterol, may also be good candidates for aspirin therapy.
The new study also found that low-dose aspirin helped prevent strokes in women by about 25 percent. That finding is especially important because, unlike men, women have more strokes than heart attacks, and they’re more likely than men to suffer and die from strokes. However, aspirin does boost the risk of hemorrhagic strokes – bleeding into the brain. Fortunately, hemorrhagic strokes are less common than strokes caused by blood clots.
Anyone – male or female, young or old – who’s thinking about taking aspirin on a daily basis should first check with their doctor. And regardless of your age, your risk group, and your decision about aspirin, lifestyle adjustments in diet and exercise offer the best protection against heart disease and stroke. In fact, experts estimate that 80 percent of heart attacks and strokes could be prevented if people followed healthy lifestyle habits. Harvard research has shown that the following behaviors help reduce the risk of having a heart attack or stroke:
• Don’t smoke.
• Eat plenty of fruits, vegetables and whole grains. Have at least two servings of fish per week.
• Avoid trans fats, and limit your intake of high glycemic-load foods such as sweets and refined-grain breads, cereals and pasta.
• Drink alcohol in moderation or not at all. Women should have no more than one drink per day. (One drink equals 12 ounces of beer or 5 ounces of wine or 1.5 ounce of spirits.)
• Get at least 30 minutes of moderate exercise, such as brisk walking, most days of the week.
You should also try to maintain a healthy weight. Know your cholesterol and blood pressure numbers and be screened for diabetes. If your cholesterol or blood pressure are too high despite lifestyle changes, see your clinician and consider taking medications.
Submit questions to the Harvard Medical School Adviser at www.health.harvard.edu/adviser. Unfortunately, personal responses are not possible.