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Aspirin May Block Strokes in Women; Study Results Mixed on Its Anti- Heart Attack Benefits

Posted on: Tuesday, 8 March 2005, 15:00 CST

Orlando, Fla. In a surprise finding that may change the advice that women get from their doctors, a large study found that women who took a low-dose aspirin every other day had a significant reduction in strokes. It also found that aspirin cut heart attacks in those over 65, but not for younger women.

Stroke is the third-leading killer of women in the U.S., and women on average have heart attacks about 10 years later than men, which may explain why aspirin did not lower the heart attack rate in women aged 45 to 65.

The 10-year study involving 39,876 women had been much anticipated because of a lack of data on the protective effect of aspirin in women.

Researchers have long known that aspirin can prevent heart attacks in men, especially second heart attacks.

While they expected a similar benefit in women, researchers found that it only seemed to protect those over the age of 65, reducing heart attacks by 34%. For women between 45 and 65, aspirin offered no heart protection.

However, aspirin use cut the rate of all types of strokes by 17% for all the women in the study. For those 65 and older, the reduction was 22%.

That finding is significant because women suffer a higher proportion of strokes to heart attacks than men.

"Of all the cardiovascular problems, stroke is the most devastating," said Jane Kotchen, a women's health researcher and professor of epidemiology at the Medical College of Wisconsin. "This is something that women can do that's inexpensive and easy to carry out."

However, because of the potential for bleeding, Kotchen and other researchers recommended that women discuss the risks and benefits of aspirin use with their doctors.

The findings from the Women's Health Study were presented Monday in Orlando at the American College of Cardiology annual meeting and published online in the New England Journal of Medicine. The study was funded by the National Heart, Lung and Blood Institute, the National Cancer Institute, Bayer HealthCare and the Natural Source Vitamin E Association. In addition, several of the authors have worked as consultants for aspirin-maker Bayer.

The study also looked at vitamin E, a controversial supplement that had shown promise in earlier studies but has failed to live up to those expectations in more rigorous trials.

Once again, the supplement has baffled researchers.

Women in the study who took 600 international units of vitamin E every other day saw no statistically significant reduction in heart attacks or strokes. But when researchers looked at all heart- related deaths, which included sudden cardiac death, they found a 24% reduction.

Senior author Julie Buring said that finding could not be explained by previous research and, indeed, contradicted nearly all of the previous clinical trials of vitamin E, which have failed to find a benefit.

"There is little evidence that vitamin E confers a benefit in well-nourished groups in terms of cardiovascular disease," said Buring, a researcher with Harvard Medical School.

But the surprise cardiovascular death reduction needs to be investigated further, she said.

However, it was aspirin's stroke benefit that has excited many doctors.

"This is important because it gets to that lower-risk group of women," said Sidney Smith, a professor of medicine at the University of North Carolina at Chapel Hill. "The reduction in stroke does not parallel what we have seen in men."

The study is not likely to change recommendations for reducing first heart attacks in women, but many doctors now may consider aspirin as a stroke preventive, Smith said.

Earlier studies suggest that the benefits of aspirin can be obtained by taking less than 100 milligrams a day, reducing the risk of bleeding, Smith said. A baby aspirin is 81 mg.

Those studies showed that taking 200 mg or more a day resulted in 4% of people having serious gastrointestinal bleeding. Less than 100 mg reduced the bleeding rate to 2%, he said.

Last year the American Heart Association issued recommendations that advised against aspirin use in women at low risk for a heart attack.

The new trial does not change that recommendation for women under 65. However, healthy women over 65 may now want to consider taking aspirin, the association said. That decision will have to be balanced against the potential bleeding risk.

Bleeding in the brain is of greater concern in people with high blood pressure, which puts more stress on blood vessels.

KEY FINDINGS

-- Use of low-dose aspirin cut the rate of all types of strokes by 17% for all women in the study.

-- For those 65 and older, the reduction was 22%.

-- Low-dose aspirin reduced heart attacks by 34% for women older than 65.

-- For women between the ages of 45 and 65, aspirin offered no heart protection.

Copyright 2005, Journal Sentinel Inc. All rights reserved. (Note: This notice does not apply to those news items already copyrighted and received through wire services or other media.)

Source: Milwaukee Journal Sentinel

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