D. Mulrow, MD,
is a member of the U.S. Preventive Services Task Force. She is also Deputy
Editor of Annals of Internal Medicine, Program Director of the Robert
Wood Johnson Foundation's Generalist Physician Faculty Scholars Program,
and Clinical Professor of Medicine at The University of Texas Health Science
Center at San Antonio.
Aspirin, Your Heart and You
Women need to take care of their hearts. Every year, nearly 500,000 American
women suffer a heart attack, making it the single leading cause of death of
American women. According to the American Heart Association, 63 percent of women
who die suddenly from a heart attack have no previous symptoms.
We know that if you have already had a heart attack, aspirin can help to prevent
another one. New recommendations from the US Preventive Services Task Force,
an independent, private-sector panel of experts in prevention and primary care
sponsored by the federal Agency for Healthcare Research and Quality, indicate
that aspirin can also prevent a first heart attack. If you are a post-menopausal
woman; a male over 40; a young person who smokes; are overweight; have diabetes;
have hypertension, and/or have a family history of early heart disease, you
are at risk for heart disease and possibly a good candidate for aspirin therapy.
How Does Aspirin Work To Prevent Heart Attacks?
Aspirin improves blood flow by reducing the
stickiness of the platelets -- the cells that cause blood to clot. Regular aspirin
use helps prevent clots from forming as readily and helps to keep arteries open.
What Are the Risks?
Regular aspirin use can cause bleeding in the
stomach or brain, especially if you have uncontrolled high blood pressure. Aspirin
is most beneficial if you're at high risk (anything over 3 percent) for developing
a heart attack within the next 5 years. People at low risk may be harmed by
aspirin because the risk for serious side effects is higher than the risk of
a heart attack.
How Can I Find Out My Risk for a Heart Attack?
Several things determine your risk, such as
sex, age, blood pressure, total serum cholesterol level, diabetes, and cigarette
smoking. To calculate your own risk, consult one of the easy-to-use risk assessment
tools on the Internet, such as the National Cholesterol Education
Program's calculator for estimating your 10-year risk of having a heart
attack. This site gives the 10-year risk, to determine your 5 year-risk,
simply halve the 10-year estimate.
If I'm At Risk, Should I Start Taking Aspirin?
No. Please do not make this decision on your own. The Task Force strongly recommends
that if you are at risk, you discuss your risks and the benefits and harms of
aspirin therapy with your doctor or health care provider. Aspirin is a powerful
drug and it's not the right answer for everyone.
If My Doctor Says It's Okay, How Much Should I Take and How Frequently?
Talk with your doctor about the right dose for you. The studies found that
as little as 75mg of aspirin daily -- the amount in a low-dose aspirin -- provided
as much benefit as a higher dose. And higher doses can be more harmful than
Is Coated or Buffered Aspirin Any Safer?
No, enteric-coated or buffered aspirin is not
necessarily better at preventing bleeding than regular aspirin. If you have
uncontrolled high blood pressure or take other nonsteroidal anti-inflammatory
agents such as ibuprofen, you are at particular risk of bleeding. If you take
warfarin or other anti-coagulants, aspirin is generally not recommended. In
any of these cases, it is especially important to talk with your doctor.
Do Painkillers Such as Tylenol or Anti-Arthritis Drugs Have a Similar Effect?
No. Other painkillers simply don't have the
clot-inhibiting protection of aspirin. Even the newer cholesterol-lowering statin
drugs don't have aspirin's unique ability to prevent heart attacks.
What Else Should I Be Doing?
First, talk with your doctor to see if aspirin therapy makes sense for you.
If you're a cigarette smoker, have uncontrolled high blood pressure, or are
diabetic or overweight, get these problems under control. Stop smoking. Eat
a healthy diet, exercise, and reduce your stress. That way, you'll not only
reduce your risk for a heart attack, you'll strengthen your overall health.
And that can only improve your life and longevity!
Click here for more information.
Created: 4/7/2002  - Cynthia D. Mulrow, MD