Tony Lambert delphine1939@videotron.ca

From the National Women's Health Report: Heart Disease - From Prevention to Intervention

Half a century ago, a California general practitioner named Lawrence Craven noticed that none of the 400 men he prescribed aspirin for had suffered heart attacks. Figuring there was some connection, he began recommending an "aspirin a day" for all his patients and colleagues.

Although Dr. Craven's observations occurred in 1948, it took another 54 years of research and data before the idea of aspirin as a heart attack preventative was fully accepted. Today, the American Heart Association and the U.S. Preventive Services Task Force recommend that people at high risk for heart attack or stroke discuss taking a daily, low-dose aspirin with their physicians.

The reality, however, is that women, especially women with diabetes, are much less likely to be on aspirin therapy than men.

"We believe this is related to physicians not recognizing that women are at high risk of cardiovascular disease when, in fact, they are," says Lori Mosca, MD, PhD, director of the preventive-cardiology program at NewYork-Presbyterian Hospital and the Columbia University Center for Heart Disease Prevention in Manhattan. "We also believe that many physicians don't feel there's as much data on women to support the use of these therapies."

However, Jayne Middlebrooks, MD, an Atlanta cardiologist, says "everyone with diabetes or three or more risk factors for heart disease should consider taking aspirin therapy." Women with diabetes are three to seven times more likely to develop heart disease and have a heart attack, and are at much greater risk of having a stroke than women without diabetes.

While there's no question that women with diabetes should take a daily, low-dose aspirin, a study presented at the American College of Cardiology meeting and published in the New England Journal of Medicine in March found that low-dose aspirin did not appear to prevent first heart attacks in healthy women ages 45 to 65, although it did significantly reduce their risk of ischemic stroke. Of course, check with your healthcare provider before starting or stopping aspirin therapy.

For women who should be on aspirin therapy, it doesn't take much to get the benefits. Studies find that between 75 and 100 milligrams, known as "low-dose aspirin therapy," is enough to reduce the risk for heart attack or angina. Most aspirin brands, including St. Joseph Aspirin and others, come in low-dose formulations of 81 milligrams (mg).

Aspirin is also important if you think you're having a heart attack. First, the American Heart Associations recommends, call 911. Then chew two 81 mg aspirin tablets unless you have any allergies to aspirin or serious bleeding issues. Once you receive medical attention, the aspirin therapy should be continued. Studies find that aspirin taken during a heart attack reduces the risk of death by 23 percent.

Aspirin's cardioprotective benefits stem from its unique ability to make blood cells that are partially responsible for forming clots less sticky. Aspirin also soothes inflammation in the arteries, which helps protect blockages from breaking off.

Aspirin has a downside, however. Because it acts on the overall system that affects bleeding, aspirin also increases the risk of gastrointestinal bleeding, either from an ulcer or gastritis, and the risk of a rare but dangerous form of stroke caused not by a blood clot, but by bleeding in the brain. This fact, and the lack of strong enough evidence to support a change in labeling, led the U.S. Food and Drug Administration panel in December 2003 to vote against including "primary prevention of heart attack" in the indications for use of aspirin on the medication's label.

The message for now: Carry an aspirin with you in case you have a heart attack, and talk to your health care professional about what's best for you in terms of preventing heart disease.