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Cynthia 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 helpful. 

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!

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Created: 4/7/2002  -  Cynthia D. Mulrow, MD

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