Daily aspirin prevents heart attacks
in men, but not in women, confirms a study in the October
18 BMC Medicine.
The Canadian research team looked
at 23 previous studies with over 113,000 patients and
found that only men benefited from aspirin's ability
to prevent a first heart attack. It's still not clear
why there's a difference. Aspirin does prevent stroke
in women, but many of your female patients are probably
taking it under the illusion it will prevent heart attacks
too. "The study just proves that patients should not
self-medicate," says lead author Dr Don Sin, a respirologist
at UBC.
So who should be taking aspirin
and when? Here are some things you can tell your patients,
to set the record straight.
PREVENTIVE
USES
Aspirin rules for men Aspirin cuts the risk of
a first non-fatal heart attack, but there's a caveat.
"I don't think all men should take it for primary prevention,
that wouldn't make sense," says cardiologist Andreas
Wielgosz, spokesperson for the Heart & Stroke Foundation.
"It's only if the number of risk factors is significantly
increased, like a strong family history of heart attack,
high cholesterol or inactive lifestyle."
Aspirin rules for women
Your female patients should be aware that though aspirin
won't prevent a first heart attack, it will prevent
stroke. "I think that women at high risk [for all cardiovascular
disease] should take aspirin," says Dr Wielgosz. "It
may prevent stroke more than heart attack, but that's
still a good reason to take it." Dr Sin agrees. "The
risk factors for stroke are similar to heart attack,
but there are subtle differences," he says. For example,
systolic blood pressure is more important in stroke,
while diastolic blood pressure is the one to watch for
in heart attack, he adds.
Other cardiovascular events
"Most definitely both men and women should take aspirin
daily if they've had a heart attack or stroke," says
Dr Wielgosz emphatically. This puts them in the high
risk category, adds Dr Sin. Explain to your patients
that aspirin's blood thinning ability will spare them
secondary cardio troubles.
How much should they take?
"The doses that are recommended are lower today than
a few years ago," says Dr Wielgosz. The 81mg tablet
baby aspirin has been approved to protect the heart
since 1998, so tell your male and female patients not
to take the full dose regular tablets — they might
actually be risky.
Chest pains Whether they're
a man or a woman, let your patients know that if they're
suffering from unstable angina or chronic chest pains,
aspirin reduces their risk of dying.
On the spot fix for heart attack
"If the patient is in the process of having a heart
attack or suspecting a heart attack, they should take
aspirin," says Dr Wielgosz. Tell them to seek emergency
medical help right away, but in the meantime aspirin
helps.
SIDE
EFFECTS
Remind your male and female patients not to take aspirin's
safety for granted. Some situations call for careful
monitoring even with low doses of this mild med.
Mixing meds can nix benefits
Your patients should discuss with you first if they're
taking other pain meds while on aspirin therapy. "Taking
other NSAIDs, for example, would increase the risk of
hemorrhage," says Dr Sin, "while taking a COX-2 inhibitor
would increase the heart risk." Caution them also against
using another pain reliever, like ibuprofen or acetaminophen,
to prevent heart attacks or strokes. Only aspirin has
shown that benefit, so they shouldn't make assumptions
about the others.
Bleeding risk "Aspirin thins
the blood out, so people who are susceptible to hemorrhage
can bleed more readily, and it can be in dangerous places
like the brain or abdomen," says Dr Sin. "Patients should
discuss with their physician the risks versus the benefits
of taking aspirin," Dr Wielgosz recommends.
Not for everyone In light
of the new findings, aspirin might not be the right
option for them. "This is especially true for women
and aspirin," Dr Sin stresses.
print
and keep info for your patients
DO TAKE ASPIRIN...
- to prevent
a first heart attack, if you're a male with
high cholesterol, inactive lifestyle, family
history of heart trouble
- to prevent
a first stroke, if you're a female with high
systolic blood pressure, diabetes, family history
of stroke
- to prevent
a second heart attack or stroke (for men and
women)
- to treat
chest pains
DON'T TAKE ASPIRIN...
- if you're taking other NSAIDs
or pain relievers that might interfere with
it
- if you have ulcers or a high
risk of bleeding
Always talk to your doctor
before starting daily aspirin therapy
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