An Aspirin a Day?

For years, aspirin was often recommended to prevent heart attacks and improve circulation. Some recent large research studies give greater information that can help guide its use.

Aspirin has been shown to be effective in the treatment of a heart attack (myocardial infarction) and in preventing recurrence after a heart attack occurs. It seems to work for both men and women. Before the Women's Health Study (WHS), there was no definite indication that aspirin would help prevent a first heart attack. The WHS looked at almost 40,000 healthy women for ten years, while giving them either aspirin or a placebo (a fake pill). Besides looking at aspirin's affect on heart attacks, another concern was whether aspirin had an effect on strokes. Did it increase the risk of a hemorrhagic (bleeding into the brain) stroke or decrease the risk of an ischemic (decreased blood flow) stroke? The WHS looked at whether these women during the ten years had a heart attack, stroke, coronary bypass or angioplasty, TIA (transient ischemic attack), or death from cardiovascular disease. Another research study looked at the use of warfarin (*Coumadin®) or aspirin for prevention of stroke. Of these two, there was no difference of success using either drug, but the risk of hemorrhagic stroke was higher in the group using warfarin.

The results of the WHS were quite compelling. It found that aspirin decreased the ischemic stroke rate by 17 percent. Aspirin also decreased the occurrence of TIAs. Bleeding is a concern when taking daily aspirin, so it was noteworthy that the rate of hemorrhagic stroke was not significantly increased. However, gastrointestinal bleeding occurred at a higher rate. Surprisingly, the researchers discovered no difference overall between those taking aspirin and those taking the placebo as far as decreasing fatal or nonfatal heart attack or death from other cardiovascular disease. In fact, the only group that benefited from aspirin was women over age 65. In this group of women, there were fewer heart attacks, strokes, or other cardiovascular causes of death. This benefit occurred regardless of menopausal status and whether or not hormone replacement therapy was used. Keep in mind that this study looked only at women who had never had a heart attack, stroke, or other cardiovascular event. The benefits of aspirin in both men and women after a cardiovascular event have been shown in multiple clinical studies.

The bottom line is that the benefits of the use of aspirin must be compared to the risks of bleeding. This is something that only you and your health care provider can decide. The role of aspirin in preventing cardiovascular events or preventing recurrence will be based on many things, and your health care provider can help you make the decision to use or not use aspirin.

About the Author: Janice D. Nunnelee, PhD, RN, CVN, ANP, is the medical editor of Keeping in Circulation. Janice is a certified vascular nurse and an adult nurse practitioner.

*Coumadin is a trademark of Bristol-MMyers Squibb Companny