The 2007 update of the American Heart Association's guidelines for women has led to some confusion regarding the use of aspirin.
My wife read the following statement in an article about the new guidelines in our local newspaper: "The guidelines suggest that women 65 and older consider taking aspirin to prevent heart attack and stroke even in the absence of risk factors." She immediately asked me whether she should start taking aspirin every day. I answered, "First, let me read the article describing the guidelines."
The guidelines do indeed state that women 65 years or older should consider taking low-dose aspirin (81 mg daily or 100 mg every other day), and there is no mention that the presence of risk factors should affect this decision.
However, the recommendation also says that these women should only take aspirin, which prevents clumping of blood platelets, if blood pressure is controlled — the unmentioned reason for this is that high blood pressure (hypertension) is associated with an increased risk of hemorrhagic stroke or bleeding within the brain.
Implementation of this guideline becomes even more problematic in light of the statement that aspirin should only be taken by these women if the "benefit for ischemic stroke and heart attack prevention is likely to outweigh the risk of gastrointestinal bleeding and hemorrhagic stroke."
So, how can I answer my wife without first assessing her likelihood of having a heart attack or ischemic stroke? And how can I make an educated guess about these possibilities without considering her risk factors? I haven't yet decided what answer to give her; but since she has no immediately apparent risk factors for either heart attack or ischemic stroke, I will probably advise against her starting daily aspirin. On the other hand, because she has taken aspirin in the past without any ill effects, she is unlikely to develop gastrointestinal bleeding if she decides to ignore my recommendation and starts taking a daily aspirin.
In short, it's not so easy to decide whether healthy women 65 or older should start taking aspirin. My strong advice is to consult your doctor before making any decision, though I'm not at all sure he or she will be able to make the right decision.
The AHA aspirin guidelines are more straightforward regarding those women at high risk and younger than 65. High-risk women — generally those with known cardiovascular disease or diabetes — should take 75 to 325 mg of aspirin daily. (For some women, this dose is higher than in previous guidelines.)
The guidelines, however, make no mention here of avoiding aspirin if high blood pressure is uncontrolled. These women should take clopidogrel (Plavix) if they cannot tolerate aspirin.
Routine use of aspirin is not recommended for preventing heart attacks in women less than 65 years of age. But — such women should consider aspirin if their risk of ischemic stroke outweighs the danger of adverse side effects. Once again, your doctor will need to make a difficult decision.