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No Heart Benefits Found in Women's Aspirin Use

Posted on: Wednesday, 9 March 2005, 12:00 CST

Regular use of low-dose aspirin does not help prevent first heart attacks in women as it does in men, a 10-year study of healthy women has found.

Participants in the Women's Health Study who took 100 milligrams of aspirin every other day were no less likely to suffer heart attacks than those in another group who took placebos. Each group had about 20,000 members. But aspirin did appear to help protect the women against strokes something the drug has not been conclusively found to do for men.

"What was really surprising and not anticipated was this gender difference," said Dr. Elizabeth Nabel, director of the National Heart, Lung and Blood Institute, which helped finance the Women's Health Study. The study of healthy women older than 45, conducted by researchers at Brigham and Women's Hospital in Boston, was the first large clinical trial to look specifically at the effects of aspirin on women.

The results were presented Monday at the meeting of the American College of Cardiology in Orlando, Florida, and will be published in the March 31 issue of The New England Journal of Medicine.

The women taking aspirin had about the same number of heart attacks as the participants taking a placebo. But the number of strokes in the aspirin group was 17 percent lower. And the aspirin takers had an especially low risk of ischemic stroke, the most common kind, caused by a blood clot in an artery leading to the brain 24 percent lower than the placebo group.

The risk of hemorrhagic stroke, the kind caused by bleeding, was slightly higher in the aspirin group, as expected, because aspirin reduces clotting.

"The fact that there was a benefit on stroke is very important for women," said Dr. Julie Buring, the principal investigator, "because we had many more strokes in our study than we had heart attacks."

Over the 10 years that the study was conducted, the subjects had a total of 391 heart attacks and 487 strokes. The greater number of strokes points out what may be an important difference between men and women and may explain why heart disease is often considered less of a problem for women than for men even though more women than men die of it each year, Nabel said.

"Perhaps in the past cardiologists have focused a lot on the heart and heart attacks and haven't focused sufficiently on strokes," Nabel said. "Perhaps this will lead cardiologists, neurologists, internists and family practitioners to think more broadly about how cardiovascular disease really affects the heart and the brain." Given that both strokes and heart attacks are caused by blood clots in the arteries, it is not immediately clear why aspirin protects only against strokes in women. The explanation may have something to do with the size of the blood vessels that lead to the brain, which are somewhat smaller than those that lead to the heart, Buring said.

Buring said recommendations for aspirin use by women who have not had a heart attack or stroke should be reconsidered in light of the new findings. Only for the 4,000 women in the study who were 65 or older did aspirin appear to be protective. The aspirin takers in this age group had a 26 percent lower risk of a major cardiovascular problem than those who took placebos. Their risk of heart attack, in particular, was 34 percent lower. Buring noted that a woman's risk of heart attack rises later in life than a man's.

Source: International Herald Tribune

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