Your husband is on daily aspirin. Should you be? Which women can safely use aspirin to protect against cardiovascular disease?

Women and aspirin… safe or not?

Recent meta-analyses (analysis of large groups of clinical trials and clinical guidelines) were performed to try to figure out which women would be helped by taking daily aspirin to prevent heart attacks and strokes, and which women might be more harmed.

The data show there are 3 groups of women who are excellent candidates for daily aspirin:

  1. Women of any age with established cardiovascular disease.
  2. Women 65 years or older with or without a history of cardiovascular disease.
  3. Women at any age with increased risk of being vulnerable to cardiovascular disease within the next decade; even just a 10% increased risk, and even in absence of prior adverse cardiovascular events.

How did they figure out it’s good for older women and not younger (unless they are at uniquely increased risk)? This was gleaned from data from the Women’s Health Study. This is the only large-scale randomized trial evaluating aspirin for primary prevention on women; it looked at 39,000 women with low-dose, daily usage. The data showed only a small non-significant 9% reduction in total nasty heart issues.

But if they broke down the results and looked at older versus younger women, the results changed greatly (like what happened with the Women’s Health Initiative and Hormones). Results varied greatly based on age.

For younger women who had more serious bleeding events, the risks outweighed the benefits. (Though the literature now suggests that those that are more likely to bleed from daily aspirin are women who have a stomach bug called h. pylori, and identifying and treating this bug may reduce this risk).

On the other hand, aspirin protected women 65 years of age and older. Older women on daily aspirin had a statistically significant 26% reduction in total cardiovascular events and a 30-34% reduction of heart attack and ischemic stroke (artery to the brain is blocked).

Overall, it appears that women at highest risk benefit the most.

But aspirin has potential serious side effects:

  1. GI bleeds, (though recent research has shown that folks prone to bleeds are because they have hidden infections in the stomach with a bug called H. pylori. Everyone looking to take aspirin regularly should get tested for H. pylori and treated if found positive to reduce potential bleeds. Berkson’s note)
  2. In some studies it’s been linked to hemorrhagic stroke (blood vessel ruptures and bleeds out into the brain).

What was the therapeutic dose? 81-100 mg daily. Women with a history of heart disease or diabetes may need higher dosages needed.

Who should not take daily aspirin for heart protection:

  1. Women with a history of bleeding events.
  2. Women with an allergy to aspirin.
  3. People with chronic kidney disease may not do well on higher dosages.