New Health Guidelines: Should You Take Aspirin?
While 50% of our population is female, 100% of us have females in the family who are at risk ultimately for heart disease. A group of medical societies and associations have recently put together a set of guidelines for heart disease prevention that have been endorsed by the American Heart Association, among others. These guidelines were then picked up and disseminated by many newspapers through the Associated Press, New York Times and Reuter’s news syndicates.
But what do they really mean, and does every woman now have to start taking aspirin or put in an emergency call for guidance from her physician (as the newspapers suggest)?
In multiple studies, done initially in men, then in men and women, and more recently in women alone, aspirin has been demonstrated to have a beneficial effect on large populations of people who are at risk of having a stroke or heart attack.
When a study of 1,000 people at 10% risk over time is done, we expect 100 people to have a stroke or heart attack during follow up. If aspirin reduces the risk by 50% (as it does in some studies), only 50 people will have a stroke or heart attack. Thus treating 1,000 people will save 50 strokes or heart attacks. If the risk of an attack is 20%, 200 attacks will be reduced to 100 by treating 1,000 people and 100 people will be benefited by aspirin. Likewise, if the risk of an event is less, the benefit is less.
Since strokes and heart attacks are disabling, and no one wants them, the idea that we can prevent some with an inexpensive medication that is readily available everywhere seems to be quite attractive, unless there is an excess risk. What are the risks? Allergies to aspirin, bleeding (most a minor annoyance but sometimes a major problem), and gastrointestinal ulcers are the main ones.
What does this mean to the “average woman?" Easy, the higher your risk, the more you are personally likely to benefit from the use of aspirin unless there is some reason that you cannot take aspirin.
How do we figure out the risk?
The more of the following that are actually present, the more of a chance that you or your relative will benefit from aspirin:
Family history of blood clots
Age over 45
High blood pressure (even if controlled)
High blood sugar (either diabetes or impaired glucose tolerance, even if treated)
High cholesterol (even if treated)
Menses have stopped (for whatever reason)
History of cancer
Taking female hormonal substitutes or birth control pills
Your personal history of heart attack, stroke, stenting, bypass surgery, peripheral vascular disease, or blood clot also contributes.
And how much aspirin?
This is debatable. The easiest answer is between no less that 81 mg per day and no more than 325 mg per day. You can ask your doctor’s preference, but there is really no good data to show that one dose is better than another.
If you cannot take aspirin, there are some alternatives. One important caveat: Aspirin should be avoided if your blood pressure cannot be controlled, if you are about to undergo surgery (ask your doctor), if you have active bleeding from ulcers, if you have an allergy to aspirin, if you have certain kinds of bleeding problems that may be worsened by aspirin.
By the way, for those not of the female persuasion, the recommendations are the same. Note that we do use “female hormones” for the treatment of prostate cancer.
Some things that I have previously touched on regarding nutritional supplements are dealt with in the new guidelines. These include the total absence of any benefit in preventing heart disease that has been demonstrated by the addition of extra folic acid, or antioxidants of any description. Likewise, the use of Vitamin C, "Vitamin E," and beta carotene have proven to be duds for the prevention of heart attacks and strokes. That doesn’t mean that someone won’t try to sell them to you though.
And the usual things that a doctor will generally recommend including 30 minutes of heart rate raising exercise per day (frankly, it takes 60 minutes to do this if you warm up by stretching, and have to change clothes either before or after you exercise), and a diet low in fats. With regard to the latter, going high protein and low carbohydrate as opposed to low protein and high carbohydrate probably doesn’t make much difference if the calories are the same. Fruits and vegetables are high in carbohydrates but are necessary fuel. Carbohydrates that are complex, and therefore a bit more difficult to digest, are usually better for you. Examples of these include whole grain and high fiber foods. Be alert to the fact however that a quick change of your diet to high fiber may meet with some resistance from your body with increased gas formation.
When it does come to protein, one generally gets it from meats, fowl and fish but you can also get it from other categories of food such as nuts or soy. In each case there is also some associated fat (oil if you like). Some of the fat is in the form of cholesterol builders, some seems to protect from cholesterol build up. The oils in fish seem to help protect against cardiovascular events, if they are not fried.
Last, but not least among the guidelines: Do not smoke!
This can’t be stressed enough. In all my years in practice, I have treated no woman for a heart attack under the age of 40 who didn’t smoke. A large majority of young women that I have seen for blood clots smoked and took birth control pills. Almost all of the young women that I have treated for strokes smoked. Maybe it was classy to smoke in the 1940 through 1970 movies, but it isn’t any more. Even if it weren’t a low-class habit, it’s not as easy to do when your arm doesn’t work, and your face is hanging twisted from a stroke. Please don’t put yourself in that awful position.
Published On: February 22, 2007