For women only - questions and answers on women's health - includes an interview with Harvard Medical School researcher, JoAnn E. Manson - Cover Story

Nutrition Action Healthletter, March, 1995 by Bonnie Liebman

AN ASPIRIN A DAY?

Q: Do other risks and benefits differ for men and women?

A: Yes. For example, we know from the Physicians' Health Study that the benefits of taking aspirin outweigh the risks in men, but we don't yet know about women.

Our Nurses' health Study suggested that women who took one to six regular aspirins a week had about a 30 percent lower risk of heart attacks than non-users. But that study wasn't a clinical trial in which participants were randomly assigned to take low-dose aspirin or a placebo. We're looking at that now in the Women's Health Study.

Q: What are the risks of taking aspirin?

A: Aspirin can cause serious gastrointestinal bleeding and shouldn't be used without consulting a physician first. And in the Physicians' Health Study of men, aspirin seemed to increase modestly the risk of hemorrhagic stroke, though that may not be borne out in future studies. But as irin also drastically lowered the risk of first heart attack, which is much more common than stroke in men.

Q: How might women differ?

A: Women have a risk of stroke that's about the same as men's, but - until they're older - a much lower risk of heart disease. So the benefits may not outweigh the risks for them.

Q: So women should ask their doctors about aspirin?

A: Yes, unless they're younger than 40 and are at low risk of heart disease, which means they don't need aspirin. And that's likely to apply to men, too.

Also, aspirin has been conclusively demonstrated to reduce the risk of a subsequent heart attack or stroke in both men and women who have already had a heart attack, a transient ischemic attack - which often precedes a stroke - or a stroke, unless it was a hemorrhagic stroke.

A lot of lives could be saved by the regular use of aspirin in these highrisk individuals. Yet it's not being prescribed as widely as it should be.

LUNG, BREAST, AND COLON CANCER

Q: What about diet and cancer?

A: The best bet at this point is to eat more fruits, vegetables, and whole grains and to lower your intake of fat, especially saturated fats and red meat. The strongest evidence for fruits and vegetables is that they might reduce the risk of lung and colorectal cancer.

Q: And breast cancel?

A: The jury is still out on whether a low-fat diet reduces the risk. The Women's Health Initiative is now addressing that question [see "Ready to be Randomized?"]. The evidence is stronger for colorectal cancer. But it certainly seems prudent at this point to try to avoid fat. Some studies suggest that it's not so much the total fat as the saturated fat or even red meat that's linked to colorectal cancer, prostate cancer, and heart disease.

Q: How much red meat should women eat?

A: The less the better. Certainly less than once a week, if not less than once a month. Some would say you should never eat it. And that includes lean red meat, because there's a hypothesis - though so far little evidence - that the meat protein, and not the fat, is responsible.

Then there's the question of whether calcium will reduce the risk of colorectal cancer. There's a hypothesis that calcium binds the bile salts that the liver secretes into the intestines, which may prevent damage to the intestinal lining by the bile salts. The Women's Health initiative is looking at whether calcium can prevent colorectal cancer and osteoporosis.