Aspirin first choice for heart disease prevention in women

AHA updated guidelines reinforce the importance of treatment to prevent heart disease among women, focusing on lifetime risk.

Aspirin plays a particularly important role for older women in preventing strokes, according to updated American Heart Association guidelines.

The 2007 Guidelines for Preventing Cardiovascular Disease in Women, published in Circulation, now recommend routine consideration of low-dose aspirin therapy for women age 65 or older regardless of cardiovascular risk status. The AHA also recommends an aspirin dosage of up to 325 mg per day for high-risk women of all ages, which is an increase from the previously recommended 162 mg per day. Additionally, the guidelines recommend consideration of aspirin for women of all ages, including younger women, who are at an increased risk for cardiovascular events, including ischemic stroke.

“Aspirin should be considered for women who would benefit from it the most,” said Nieca Goldberg, MD, medical director of the New York University Women’s Heart Program. “At the present time, for all women of any age who have had a heart attack or stroke, it prevents a second. Women over 65 who are at low risk benefit from aspirin, as well.”

In addition to new aspirin recommendations, the guidelines include expanded recommendations on lifestyle changes. (See sidebar.)

Revising recommendations

The AHA updated its 2004 evidence-based guidelines to reflect the most current clinical recommendations related to cardiovascular event prevention in women aged 20 and older, and to assist health care providers in preventing initial or recurrent MI and recurrent strokes. The revised guidelines recommend evaluating women for stroke and screening women for heart disease risk starting at age 20.

“I think this is a really big step because we want women to know about their risks for heart disease early so they can work on them through lifestyle changes. [We want to] make sure we identify women at high risk so we can manage those risk factors and ultimately prevent the first heart attack,” Goldberg told Cardiology Today.

While the new guidelines urge physicians to consider a patient’s age, Goldberg said it is important to understand that age is only one of many risk factors.

“Women have to get into the ground floor early to get their heart disease risk factors assessed and continue to be assessed through their life cycle,” Goldberg said. “That is pretty much the only way we can reduce risk of heart disuse. We need to get involved with women’s lives when they are young and make it a habit.” – by Tara Grassia

Dr. Goldberg has received honoraria from Reliant Pharmaceuticals and Bayer.

For more information:

• Mosca L, Banka CL, Benjamin EJ, et al. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation [online].2007;115.