Heart group backs aspirin for women

Nearly all American women are in danger of heart disease or stroke and should be more aggressive about lowering their risk, including asking their doctors about daily aspirin use, the American Heart Association said Monday in new guidelines.

It’s the first time guidelines have urged all women to consider aspirin for preventing strokes, though specialists warn that it can cause ulcers and dangerous bleeding. They said it’s probably not a good idea for young women with no big health problems.

“We do not want women to go to the drugstore and just start taking this themselves. It is critical that every woman talk to her doctor,” said Dr. Lori Mosca, director of preventive cardiology at New York-Presbyterian Hospital and chairwoman of the expert panel that wrote the guidelines.

The guidelines were published in the journal Circulation with related studies on women’s health, including one suggesting that hormone skin patches may be safer than pills for menopause symptoms.

In general, the guidelines aim to get women and doctors to focus on the long-term risk of high blood pressure, smoking, lack of exercise or being overweight, even if the woman’s current health seems fine. Even a single risk factor at age 50 greatly raises the chance of heart disease or stroke later, and only about 10 percent of American women don’t have these problems.

“We do not want women to wait until they develop symptoms to begin to take action,” Mosca said.

The guidelines were drafted by dozens of groups worldwide, including the American Academy of Family Physicians and the U.S. government. Of the 33 people who wrote the advice, 13 have financial ties to heart drug makers, only three of them to a large degree.

The evidence shows that far more women than expected are at risk of heart disease and stroke – even those whose only weakness was failure to exercise every day. Heart disease is the leading killer of men and women worldwide.

The advice on aspirin is controversial. Aspirin is recommended to prevent heart disease in men 45 and older; but in women, a large study found it prevented heart disease only for those 65 and older.

Aspirin did prevent strokes in women, but again, the benefit was substantial only among older ones, said Dr. JoAnn Manson, a Harvard University women’s health expert who helped lead that study.

Putting young women on aspirin for stroke prevention is not justified, Manson warned. In the 10-year study, aspirin prevented only one additional cardiovascular problem among roughly 35,000 women under 65 and led to 20 cases of bleeding requiring transfusion, she said.