Aspirin may do more harm than good for certain women, due to internal bleeding risks.
The cons outweigh the pros of low-dose aspirin treatment to prevent heart disease and colon cancer in women aged 45 to 65 who are initially healthy, shows a study published online in the journal Heart.
Researchers found that in the majority of women who do not have heart disease, taking an alternate-day low-dose aspirin is not only ineffective but even harmful over the years. This is due to the increased risk of major gastrointestinal (GI) bleeding in the esophagus, stomach, intestines, rectum, or anus, which can lead to hospitalization and require blood transfusion.
“This study shows pretty consistently that there really isn’t a reduction in cardiovascular disease with aspirin therapy — if you don’t have heart disease in the first place,” says Kevin Campbell, MD, FACC, of North Carolina Heart and Vascular, and an assistant professor in UNC Department of Medicine, Division of Cardiology.
“If you have had a heart attack or you have known heart disease, then you should be on aspirin for the prevention of future events — unless you have significant GI [gastrointestinal] bleeding,” Dr. Campbell says. “But it’s probably not going to benefit you to be on aspirin if you don’t have heart disease or any risk factors for heart disease.”
Women Over 65 May Benefit From Aspirin
Taking an aspirin every other day as part of preventive care may still be beneficial for a certain group of women, those age 65 and over, according to the study. The research focused on nearly 30,000 healthy women who were at least 45 years old and took part in the Women’s Health Study. The risk of gastrointestinal bleeding from aspirin increases with age, but after age 65, the protective health benefits of aspirin therapy increase too, and outweigh the risks, researchers found. For older women, low-dose aspirin helps prevent colorectal cancer and heart disease.
“There is a role for aspirin therapy for women age 65 and over,” says Suzanne Steinbaum, DO, director of women’s heart health at Lenox Hill Hospital and the author of Dr. Suzanne Steinbaum’s Heart Book: Every Woman’s Guide to a Heart-Healthy Life. “The risk of gastrointestinal bleeding for women under 65 is too great to make it worthwhile to take the aspirin, but in older women there can be a benefit.”
Weighing Aspirin’s Health Risks and Benefits for Women
Besides its positive effect on cardiovascular health for people with heart disease, aspirin may play a role in reducing cancer risk, research has shown. Randomized trials of daily aspirin showed a notable decrease in the incidence of cancer — particularly colorectal cancer — and also in mortality.
However, these protective effects against cancer take a while to show up, emerging only after 5 to 15 years. “It takes at least several years for that benefit to accrue,” says Nancy Cook, SCD, a doctor of science at Harvard Medical School and a senior author of the new study. “When you look at the whole pattern, the effect of aspirin on colorectal cancer doesn’t contribute very much to the overall risk-benefit equation. We found there is some benefit for preventing cardiovascular disease, but it was very slight in younger women.”
As for other NSAIDs, these have the same risks of digestive system side effects as aspirin, Dr. Cook says. “Acetaminophen is a different pain reliever that does not have those side effects. But it is not anti-inflammatory, so not an NSAID, and may not have the same benefits on cardiovascular disease and cancer,” she adds.
Your Risk for Heart Disease and Stroke
You’re more likely to have cardiovascular disease if you smoke, are obese, have high cholesterol or high blood pressure, and/or have a family history of heart disease. And heart disease often results from plaque, which is cholesterol and fat that builds up on the inside of the blood vessels.
“In those women found to have plaque build-up, the benefits of taking aspirin will outweigh its risks,” says Arthur Agatston, MD,
a practicing cardiologist who is the Medical Director of Wellness and Prevention for Baptist Health South Florida and the creator of the South Beach Diet. “If a woman finds out she has plaque build-up, a discussion about taking aspirin should be had with her doctor.”
Women who have risk factors or who are postmenopausal may want to ask their doctor about a simple, noninvasive heart scan for a “calcium score,” says Dr. Agatston. The test uses a CT scan to detect the presence of coronary atherosclerosis, or plaque build-up, he explains.
More Ways to Protect Your Heart
Low-dose aspirin, with the risks of gastric bleeding, is not the only choice for preventive care for your heart. You can lower your risk of heart disease by sticking to a healthy diet and getting regular exercise, Campbell says. And, he advises, engage with your primary care physician to make sure you get checked for diabetes, high cholesterol, high blood pressure, and metabolic syndrome.
If you have any of these, make the recommended dietary changes or comply with other prescribed interventions, such as medications, Campbell says. And it goes without saying that if you smoke, now’s the time to quit. Besides causing lung cancer, smoking is a major risk factor for cardiovascular disease.