Addendum to Women's Health Study

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This study has particularly important implications for reducing the burden of cardiovascular disease worldwide, underscoring aspirin's utility and safety even in low- to moderate-risk persons. Furthermore, these findings are especially useful in development of global guidelines that broaden the appropriate use of this remarkably inexpensive drug.

It is vital that heal the a re professionals are involved in any individual's decision to take aspirin to stave off cardiovascular events such as heart attack or stroke. An aspirin regimen should never be started or stopped without consulting with a healthcare professional. As doctors and researchers continue to build a solid basis of knowledge of aspirin's potential benefits and remain mindful of the risks associated with any effective treatment, we should seek to ensure that people who can benefit from aspirin treatment receive it.

Most studies have been done in men because men between the age of 40 and 65 have more cardiovascular disease than women, we weren't, sure if the protective effects of aspirin in men also were present in women over the age of 50.

We clearly see now there is a preventive effect in women between 50 and 65 with regard to stroke. In women over the age of 65, the protective effect also has now been seen in regard to myocardial infarction as it has in men.

The data from this study do not conflict with earlier data. This trial studied healthy women with a mean age of 54 years, which is exceptionally young for- women to develop heart disease. But in women over 65, the study showed the benefits of aspirin are as big as in men from the age of 50.

I think what is really encouraging is the prevention of stroke. That is new and has never been seen before with aspirin. Stroke is so catastrophic to the patient and her family that a very cheap and effective means to prevent it is very welcome in women.

The study's major finding is that it demonstrates that aspirin can reduce the risk of a first stroke., We've been able to demonstrate this in people who have had heart attacks or 'strokes;, but never before in apparently healthy people.

Today, cardiovascular disease kills one in two Americans and one in two people in most of the rich countries. It kills less than one in three in most of the poor countries, but in the next .10-15 years it's going to become the leading killer in the world. So agents that are effective and relatively safe and inexpensive will have a large clinical and public health impact. So the wider and more appropriate use of aspirin in the treatment and prevention of cardiovascular disease can avoid many premature deaths in secondary prevention and many first heart attacks and strokes in primary prevention.

Women over 65 in the Women's Health Study comprised less than 107. of the study population and over 30X of the endpoints. Heart disease becomes the leading killer of men in the United States by age 45 but women by age 65. Therefore in the population that we could demonstrate it, we showed that aspirin prevents heart attacks as well as strokes.

With respect to advice for apparently healthy women and men, I think you've got to see your healthcare provider about the use of aspirin.

But I think based on the evidence we have today;, that among men over 50 and women over 60 there are many, many who would be candidates for aspirin, based on their absolute risk of getting a heart attack or stroke. I think we need wider and more appropriate utilization of aspirin in conjunction with a decision by the healthcare provider.

Charles Hennekens, MD, DrPH, Pounding Principal Investigator, Women's Health Study, Professor of Biomedical Sciences;, Florida Atlantic University, Miami;, Fla.

Dr Freek Verheugt, Fellow, European Society of Cardiology, Chairman, Professor of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen, The Nether 1ands.

Thomas A. Pearson, MD, MPH, PhD, member of the board the World Heart Federation and author of the American Heart Association guidelines for the primary prevention of heart disease and stroke.

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