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Risks
of using Aspirin to prevent Heart Attack or
Stroke differ by Gender and Age
Newswise — Patients and clinicians should
consider risk factors-- including age,
gender, diabetes, blood pressure,
cholesterol levels, smoking and risk of
gastrointestinal bleeding-- before deciding
whether to use aspirin to prevent heart
attacks or strokes, according to new
recommendations from the U.S. Preventive
Services Task Force.
These recommendations do not apply to people
who have already had a heart attack or
stroke.
The recommendations are published in the
March 17 issue of the Annals of Internal
Medicine.
The Task Force reviewed new evidence from
the National Institutes of Health’s Women’s
Health Study published since the last Task
Force review of this topic in 2002,
including a recent meta-analysis of the
risks and benefits of aspirin and found
aspirin may have different benefits and
harms in men and women.
The Task Force found good evidence that
aspirin decreases first heart attacks in men
and first strokes in women.
The more risk factors people have, the more
likely they are to benefit from aspirin.
The Task Force recommends that men between
the ages of 45 and 79 should use aspirin to
reduce their risk for heart attacks when the
benefits outweigh the harms for potential
gastrointestinal bleeding.
Women between the ages of 55 and 79 should
use aspirin to reduce their risk for
ischemic stroke when the benefits outweigh
the harms for potential gastrointestinal
bleeding.
Ischemic strokes occur as a result of an
obstruction within a blood vessel supplying
blood to the brain and are potentially
prevented by aspirin use. The risk of
gastrointestinal bleeding with and without
aspirin use increases with age and is twice
as high in men as in women.
Other
risk factors for gastrointestinal bleeding
include upper gastrointestinal tract pain,
gastrointestinal ulcers, and using
non-steroidal anti-inflammatory drugs.
The Task Force recommended against using
aspirin to prevent either strokes or heart
disease in men under 45 or women under age
55 because heart attacks are less likely to
occur in men younger than 45 and ischemic
strokes are less likely to occur in women
younger than 55, and because limited
evidence exists in these age groups.
People age 80 and older could benefit more
than younger people from aspirin because of
their higher risk of cardiovascular disease,
but the harms are also greater because the
risk of gastrointestinal bleeding increases
with age.
The Task Force could not find clear evidence
that the benefits of using aspirin outweigh
the risks in people 80 years or older.
“The decision about whether the benefits of
taking aspirin outweigh the harms is an
individual one.
"Patients should work with
their clinicians to look at their risk
factors and decide if taking aspirin to
lower their risk for heart attacks or
strokes outweighs the potential risk of
gastrointestinal bleeding,” said Task Force
Chair Ned Calonge, M.D., who is also chief
medical officer and state epidemiologist for
the Colorado Department of Public Health and
Information.
Cardiovascular disease is the leading cause
of death in the United States.
It is the underlying or contributing cause
in approximately 58 percent of all deaths.
In 2003, 1 in every 3 adults had some type
of cardiovascular disease.
In adults over the age of 40, the risk of
developing cardiovascular disease is 2 in 3
for men and more than 1 in 2 for women.
The Task Force could not find evidence about
what the optimum dose of aspirin is to
prevent heart attacks or strokes.
Evidence
shows benefits at a range of doses, and the
risk of gastrointestinal bleeding may
increase with the dose. A dose as low as 75
mg seems as effective as higher doses.
Taking aspirin increases a person’s chances
of gastrointestinal bleeding, the sudden
loss of blood or perforation of the
digestive tract that can lead to
hospitalization or death.
Taking aspirin also increases the chance of
a hemorrhagic stroke, or bleeding in the
brain, which is different than the ischemic
stroke that aspirin can prevent.
In 2002, the Task Force strongly recommended
that clinicians discuss aspirin use with
adults at increased risk for coronary heart
disease and that discussions with patients
should address both the potential benefits
and potential harms of aspirin therapy.
The new recommendation provides more
specific guidance about benefits and harms
to specific age groups and gender-specific
benefits and provides clinicians with
information on how to estimate an
individual’s risks for heart disease or
stroke.
The U.S. Preventive Services Task Force is
an independent panel of experts in
prevention and primary care.
The Task Force conducts rigorous, impartial
assessments of the scientific evidence for
the effectiveness of a broad range of
clinical preventive services, including
screening, counseling and preventive
medications.
Its recommendations are considered the gold
standard for clinical preventive services.
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