Women underuse aspirin to prevent heart disease
Posted by on August 26, 2012 - 8:41am

For years we criticized heart researchers for not including women in the early studies that recommended aspirin to prevent heart disease.  We asked:  How can you recommend aspirin in women when all the studies took place in males!  In 2007, after additional studies that included females, the American Heart Association released guidelines for the CVD preventive care in women including aspirin. Their recommendations:

  • Primary prevention (other at-risk or healthy women):   Consider aspirin therapy in women >65 years if blood pressure is well-controlled and benefit for ischemic stroke and myocardial infarction prevention is likely to outweigh the risk of gastrointestinal bleeding and hemorrhagic stroke.
  • Secondary prevention (high risk):  Aspirin therapy should be used in high-risk women (established coronary heart disease, cerebrovascular disease, peripheral arterial disease, abdominal aortic aneurysm, end-stage or chronic renal disease, diabetes, and 10-year Framingham risk>20%) unless contraindicated.

A recent study, using a web-based risk assessment tool found that the majority of women for whom aspirin is recommended were not following national guidelines.  The authors led by Cathleen Rivera, MD at Scott and White Healthcare in Texas concluded that there is a need for more education about aspirin among clinicians and women for increased prevention of heart disease.  Given the rising direct and indirect costs of cardiovascular disease, it makes sense that health care providers take a closer, serious look at the increased use of low cost aspirin in lieu of designer heart meds.!

Source:  Rivera C, Song J, Copeland L et al.  Journal of Women's Health, Vol. 21, 2012.

Women, aspirin and heart disease
Posted by on April 22, 2012 - 6:29am

Heart disease is the leading cause of death among women, and evidence-based national guidelines promote the use of daily aspirin for women at increased risk for cardiovascular disease. However, less than half of the women who could benefit from aspirin are taking it, according to an article  available free online at the Journal of Women's Health website*.

"Based on this survey, it is evident that the majority of women for whom aspirin is recommended for prevention of cardiovascular disease are not following national guidelines," says Susan G. Kornstein, MD,  Executive Director of the Virginia Commonwealth University Institute for Women's Health.

Among more than 200,000 women participating in a web-based survey to assess their risk for cardiovascular disease, only 41%-48% of women for whom aspirin is recommended reported that they took an aspirin daily, according to the study authors, Cathleen Rivera, MD and Texas-based colleagues. The women were more likely to use aspirin if they had a family history of cardiovascular disease or had high cholesterol, as reported in the article "Underuse of Aspirin for Primary and Secondary Prevention of Cardiovascular Disease Events in Women." The authors conclude that improved educational programs are needed to increase awareness of the benefits of aspirin use to prevent heart disease among women.

References:
Mary Ann Liebert, Inc./Genetic Engineering News  "Should More Women Take A Daily Aspirin To Prevent Heart Disease?." Medical News Today. MediLexicon, Intl., 9 Apr. 2012. Web.
12 Apr. 2012.

Aspirin for Heart Disease and Stroke Reduction: Men vs. Women
Posted by on October 18, 2010 - 3:47pm

Aspirin therapy to prevent heart attack may have different benefits and harms in men and women.

Cardiovascular disease (CVD) is the leading cause of death in the U.S., contributing to approximately 58% of deaths.  The epidemiology of CVD events is different for men and women.   Men have a higher risk for coronary heart disease and tend to have these events at a younger age than women.

Although incidence rates of stroke are higher among men than women, more women die of stroke than men because of their longer life expectancy.

Back in 2002, the US Preventive Services Task Force (USPSTF) strongly recommended that clinicians discuss aspirin with adults who are at increased risk for coronary heart disease. This preventive measure was based on 5 randomized controlled trials that showed a 28% reduction in myocardial infarctions (heart attack) with aspirin use.   Only 2 of 5 studies included women!   At that time it was not clear if the earlier recommendation base on mainly male dominated studies was valid for women. In 2005, the large Women's Health Initiative (WHI) provided some new data about the benefits of aspirin in women but confusion continued.

In March 2009, the U.S. Preventive Services Task Force reviewed new evidence from NIH's Women's Health Study and other recent research and found good evidence that aspirin decreases first heart attacks in men and first strokes in women. The Task Force has issued a recommendation that women between the ages of 55 and 70 should use aspirin to reduce their risk for ischemic stroke (lack of blood and oxygen due to a clot or other disease process) when the benefits outweigh the harms for potential gastrointestinal bleeding.

In summary, as of March 2009, the USPSTF recommends:

  • The use of aspirin for men age 45-79 years when the potential benefit due to reduction in myocardial infarctions outweigh the potential harm due to an in increase in GI bleeding.
  • The use of aspirin for women age 55-79 when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in GI bleeding.
  • The current evidence is insufficient to assess the balance of benefits and harms of aspirin for cardiovascular disease prevention in men and women 80 years or older.
  • Against the use of aspirin for stroke prevention in women younger than 55 years and for myocardial infarction prevention in men younger than 45 years.

The new report does conclude that aspirin increases the risk for major bleeding events, primarily GI bleeding in both men and women.   There is also limited evidence that hemorrhagic strokes are significantly increased among men but not women.

As with other studies we have cited on this blog, recommendations are always subject to change as new research is completed.   It is wise to discuss your individual concerns with your physician because other health factors could influence your decisions.    The entire discussion above also reinforces the need for ALL research to look at sex and gender differences even in the most basic trials so that when we want to apply  findings to humans, we already know if there are sex differences --- as we are finding out about aspirin therapy.

The recommendation and other materials are available at Exit Disclaimer U.S. Preventive Services Task Force, Ann Intern Med 150(6):396-404, 2009 (AHRQ supports the Task Force). See also Optowsky, McWilliams, and Cannon, J Gen Intern Med 22:55-61, 2007 (AHRQ grant T32 HS00020).