Low-dose Aspirin Reduces Stroke Risk in Women
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Low dose aspirin is associated with a reduction in stroke risk among women age 65 or older, according to 10-year data from the Women’s Health reported Monday at the American College of Cardiology meeting here.
But there was no significant benefit for vitamin E therapy, said Paul M. Ridker, MD, a professor of medicine at Harvard Medical School, and colleagues, reporting for the Women’s Health Study.
The study enrolled 39,876 healthy women ages 45 to 80 and randomized them to 100 mg of aspirin every other day or placebo. The women underwent a second randomization for vitamin E, half given 600 IU every other day and half placebo. The women were followed for 10 years.
While Ridker, and colleague Judy Buring ScD, a professor of medicine at Harvard Medical School, were presenting the study results, the low dose aspirin study was published online by the New England Journal of Medicine.
Among the findings:
- Aspirin was associated with a 17% reduction in stroke risk.
- Ischemic stroke risk was reduced by 24% (p=0.009).
- There was a non significant increase in risk of hemorrhagic stroke (RR: 1.24; 95 percent CI, p=0.83).
- Compared with placebo aspirin did not reduce risk of MI or death from cardiovascular disease.
Neither Ridker nor Buring expressed surprise about the vitamin E findings, but both say they were surprised by the aspirin results. “This is the exact opposite of what we see in menaspirin prevents the risk of heart attack in men but has no impact on stroke,” Ridker said.
Buring added that the new results pertain only to prevention of heart attacks or stroke in people with no history of heart disease. For people who have had heart attacks, aspirin is still recommended as a way to reduce risk of second heart attacks. “And that recommendation is for men and women,” she said. Also, for someone having a heart attack - man or woman - the recommendation is still to take an aspirin to limit the damage of the attack.
Otherwise, Ridker and Buring say that the decision to take aspirin “should be a decision between a woman and her doctor, who can weigh the risks and benefits. For women over 65, it does appear that the benefit of stroke prevention may outweigh the risk,” said Buring.
The American Heart Association responded to the study findings with a statement noting that the AHA has evidence-based guidelines for heart disease prevention in women. “These guidelines included recommendations for aspirin use among women at varying levels of risk, and advised that the routine use of aspirin in low-risk women was not recommended pending the results of ongoing trials.”
Lori Mosca, M.D., chair of the association’s writing group for the guidelines, says the results of this study support the AHA recommendations. She adds, too, that while the new study results suggest a benefit for aspirin therapy in healthy women age 65 or older, “we will have to balance this benefit with the risk of serious gastrointestinal bleeding and the potential for increasing hemorrhagic strokes.”
Robert Harrington, MD, professor of medicine and director of cardiovascular trials at Duke University School of Medicine, said that the study results provide clear guidance for women and their physicians. “The message is clear, aspirin does reduce stroke in women age 65 or older, so we need to talk about prophylactic aspirin use in our women patients in that age group.”
The study was funded by the National Heart Lung and Blood Institute.
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