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By Newsweek Editors
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Aspirin is a wonder drug, plain and simple. At high doses, it quells inflammation; at medium doses, it provides effective pain relief; at low doses, it reduces the blood's ability to clot by inhibiting the action of tiny blood cells called platelets. It makes sense, then, that aspirin might help prevent clot-related cardiovascular events such as heart attack and stroke, even in healthy people. In 1988, the Physicians' Health Study showed exactly that. In healthy men, 325mg of aspirin taken every other day for five years reduced the risk of a first heart attack by 44 percent. That was great news. For men.
It wasn't until March 2005 that the Women's Health Study addressed aspirin's benefits for women. Healthy women—who were at least 45 years old at the start of the study—who participated in the study took either 100mg of aspirin or a placebo every other day for 10 years. Surprisingly, the women taking aspirin experienced no reduction in heart-attack risk. However, aspirin takers were 17 percent less likely to have a stroke.
Since a man with atherosclerosis is more likely to have a heart attack, while a woman with the same condition is more likely to have a stroke, aspirin protects both men and women from the vascular catastrophe most relevant to them. And aspirin's benefits increase as a woman grows older. At any given age, men are at greater risk for a cardiovascular event than women are—until later in life when the drop in estrogen after menopause levels the playing field. The Women's Health Study found that aspirin provided the most consistent benefits—reducing both heart attacks and stroke—in healthy women 65 and older.
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Research clearly shows that for people with heart disease—men and women alike—aspirin protects against additional heart attacks and strokes. But there is little evidence that aspirin prevents a first heart attack or stroke in healthy women under 65. Unless such a woman has certain risk factors—being overweight, smoking, having high blood pressure, high cholesterol or diabetes—aspirin's risks probably outweigh its benefits. (To know for sure, she needs to talk with her doctor.)
As valuable as it is, aspirin is a real drug with real risks that must be weighed against its potential benefits. Because it reduces blood clotting, aspirin makes unwanted bleeding more likely. Side effects range from bruising, nosebleeds and bleeding gums to significant bleeding into the gastrointestinal tract and bleeding into the brain (a relatively rare but devastating occurrence).
Among those who already have cardiovascular disease, regardless of age, gender or other risk factors, clear and definitive research shows that aspirin greatly reduces the chances of a recurrent heart problem, and of dying from cardiovascular disease. Furthermore, we know that for a man or a woman having a heart attack, a full-strength aspirin taken chewed or crushed within six to 12 hours of the onset of chest pain reduces the likelihood of dying from that heart attack or having another one in the short term. Always call for help first, then give aspirin to the person having heart-attack symptoms.
Whatever your age, if you're considering adding aspirin to your prevention arsenal, work with your doctor to balance your personal risks and aspirin's benefits. Because that trade-off changes over time, keep the conversation going.
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