“My doctor told me to start taking aspirin every day to protect my heart,” a neighbor said at a recent gathering. “My doctor told me to stop!” said another woman. “I’m so confused about the whole aspirin question that I don’t do anything,” added a third.
It’s no wonder that women are baffled. Sometimes it seems that every new study suggesting additional protective effects from daily aspirin is quickly followed by one revealing yet another dangerous side effect. What’s more, the newest recommendations for women are different than those for men — and different than the previous guidelines for women.
To make sense of the latest research findings, I spoke with Suzanne Steinbaum, DO, director of the department of women and heart disease at the Heart and Vascular Institute of Lenox Hill Hospital in New York City. She explained why the question of whether or not to take aspirin is so complex, especially for women… and how to figure out what’s right for you.
Aspirin’s health benefits are primarily due to its ability to prevent blood from forming clots that can clog arteries. But: There also are many confounding factors to consider in weighing the risks and benefits. Here’s how regular aspirin use affects a woman’s…
Cardiovascular health. For women age 55 to 64 who have risk factors for heart disease, aspirin can prevent a first stroke… prevent a second heart attack… and reduce heart disease risk. For women age 65 and older, aspirin has these same benefits and also helps prevent a first heart attack.
Confounding factors: Aspirin’s ability to protect against heart attacks is much stronger in men than in women. Also, aspirin generally provides no protection against stroke — and, in fact, may increase stroke risk — in women under age 55. That’s because younger women are more likely to experience a hemorrhagic stroke (caused by bleeding in the brain) than an ischemic stroke (caused by blood vessel blockage).
Furthermore: New evidence suggests that people who take aspirin regularly have a greater incidence of cerebral microbleeds, which are tiny asymptomatic areas of bleeding in the brain. Although more research is needed to reveal the health consequences, such microbleeds could be harmful.
Cancer risk. Recent studies link aspirin to a reduced risk for postmenopausal breast cancer and for cancers of the colon, pancreas, skin and ovaries. Among patients with breast cancer, aspirin may reduce the chance of recurrence and/or increase survival rates.
Confounding factor: The evidence for aspirin’s potential as a cancer-prevention tool is not sufficient to recommend it for people at average risk for cancer.
Eyes. Aspirin may have a modest benefit in preventing age-related macular degeneration, a common eye disease that destroys central vision.
Confounding factor: One study reported that long-term use of aspirin increased the risk for cataracts by 55%.
Gastrointestinal tract. There are no confounding factors here — because aspirin’s potential effects on the digestive system are all bad. Reason: Aspirin interferes with the mucous lining that protects the stomach and intestines from digestive acids. The most serious concern is gastrointestinal bleeding, which can involve sudden loss of blood and/or perforation of the digestive tract.
Risk factors: Gastrointestinal bleeding risk increases with age… a history of upper gastrointestinal tract pain… and a history of ulcers.
Use the following guidelines to get a sense of whether you might be a good candidate for preventive aspirin use, then discuss the issue with your physician. Important: Make sure that your doctor is aware of all medications and supplements that you are taking. Do not start or stop taking aspirin without your doctor’s OK.
Daily aspirin is probably recommended if you meet any of these conditions…
- Have a history of heart attack.
- Have a history of ischemic stroke (not hemorrhagic stroke) or blood clots.
- Are between age 65 and 79 and are healthy.
- Are between age 55 and 64 and have two or more of the following cardiovascular risk factors…
- Atherosclerosis (thickening and hardening of the arteries).
- Blood pressure above 130/85 mmHg.
- HDL “good” cholesterol below 50 mg/dL.
- LDL “bad” cholesterol above 160 mg/dL.
- Decreased blood flow in the legs.
- Waist measurement of more than 35 inches.
- Diabetes.
- Fasting blood sugar level above 100 mg/dL.
- Sedentary lifestyle.
- Cigarette use.
- High stress levels.
Daily aspirin should be considered if you meet any of these conditions…
- Are under age 55 and have at least two of the cardiovascular risk factors listed above.
- Are age 80 or older and have no risk factors (other than age) for gastrointestinal bleeding.
- Have a history of colorectal cancer.
Daily aspirin should probably be avoided if you meet any of these conditions…
- Are under age 55 and have none of the cardiovascular risk factors listed above.
- Are age 80 or older and have any risk factors for gastrointestinal bleeding.
- Are allergic to aspirin.
- Take a blood-thinning drug, such as warfarin (Coumadin).
Take any other NSAID several times per week or more. Have uncontrolled high blood pressure… kidney or liver problems… a bleeding disorder, such as von Willebrand’s disease… or asthma that is exacerbated by aspirin. Have a history of gastrointestinal bleeding… ulcers… bleeding in the brain… or hemorrhagic stroke.
If you and your doctor decide that preventive aspirin is right for you, the standard daily dose is one low-dose or “baby” aspirin — that’s 75 milligrams (mg) to 81 mg. Though much lower than the dosage taken to ease pain and acute inflammation, it is all you need to get aspirin’s protective benefits. Higher doses taken daily or every other day offer no additional protection and carry greater risks.
Best: Don’t use enteric-coated aspirin — it has not been shown to reduce gastrointestinal problems, may not be absorbed well into the bloodstream and costs more. Take aspirin with food to minimize the risk for gastrointestinal problems. After taking any blood pressure-lowering medication, wait at least one hour before taking your daily aspirin.
Caution: When taking aspirin, the following dietary supplements should be avoided because they may increase the risk for bleeding — danshen, dong quai, evening primrose oil, feverfew, ginkgo, policosanol and willow bark.
If you do not need aspirin therapy or fall into the borderline category and want to try safer options for cardiovascular protection, Dr. Steinbaum recommends talking with your doctor about supplementing with 1,000 mg of fish oil daily, plus any or all of the following natural anticoagulants…
- Bromelain (an enzyme found in pineapple) at 500 mg three times per day (do not use bromelain if you have a history of ulcers).
- Nattokinase (an enzyme made from fermented soybeans) at 100 mg per day.
- Vitamin E at 800 international units (IU) to 1,200 IU per day.
Source: Suzanne Steinbaum, DO, director of the department of women and heart disease at the Heart and Vascular Institute, Lenox Hill Hospital, New York City, and a founder of Women’s Cardiac Care Network, a citywide public health program. She lectures nationally and on-air. http://www.srsheart.com/