An aspirin a day may help keep a heart attack away, but many women at risk for heart disease still don't take one, a new study finds. Men, by comparison, are more likely to pop aspirin regularly — but less likely than women to remember or follow advice about diet and exercise habits that can help their hearts.

The gender differences found by a U-M team in a recent study persisted even when the researchers took into account how much heart-related risk individuals faced, and how often they went to the doctor. And large numbers of both men and women hadn't yet made diet or exercise changes, even those at high risk.

But the study also finds some good news: Men and women are getting their cholesterol and blood pressure checked at about the same rates.

The findings, made by a U-M lead team with help from the Centers for Disease Control and Prevention, used CDC data from telephone interviews with more than 97,000 Americans in 20 states.

It is the first study to stratify a broad population by individual heart disease risk, and to look at a range of medical and lifestyle practices that have been proven to help people reduce their risk of heart attack, stroke or other cardiovascular problems.

"We hope that these findings will help guide risk-reduction efforts for both men and women, and help remind women to speak up to their doctors about preventive measures such as aspirin that can help them if their risk is high," says lead author Catherine Kim, M.D., M.P.H., an assistant professor in the departments of Internal Medicine and Obstetrics & Gynecology at the U-M Medical School.

The aspirin finding, Kim says, echoes other recent evidence from the same CDC survey project. Among people with diabetes — whose disease puts them at much higher risk for heart disease — women were prescribed aspirin less often than men.

In the new study, women were more likely than men to say they had stopped taking aspirin regularly, often because of stomach-related symptoms. But even this difference in tolerance can't account for the difference between the numbers of men and women who take aspirin every day or every other day.

No matter what their level of risk of heart disease, women were far less likely to take aspirin regularly: 26.2 percent overall versus 34.8 percent of men. Among high-risk respondents, the difference was larger: 45.5 percent of high-risk women took aspirin, as opposed to 58.5 percent of men. Even after adjusting for age, race, education, insurance, health status, and time since last checkup, the difference between the genders persisted.

When it came to diet and exercise, the proportions of both men and women who remembered getting advice from their doctors went up as the risk level went up. And among low- and medium-risk individuals, a larger percentage reported they had been dieting and exercising than the percentage who remembered getting advice on those matters from their doctors.

But women were slightly more likely than men to be dieting and exercising, except among high-risk people, where men barely outpaced the women in exercising. All in all, says Kim, many men and women weren't making these key lifestyle changes: only about two-thirds of either gender reported exercising, and two-thirds to three-quarters reported changing their diet. The group with the highest percent of either lifestyle change was high-risk women: 80 percent of them had made diet changes.

"This just reinforces how hard it is to change people's behavior, even among high-risk people who have lived through a heart attack, stroke, diabetes or coronary heart disease," says Kim. "People develop these diseases because of their lifestyle, and we're asking them to change that lifestyle to avoid getting worse. There are many people who should be modifying their behavior, and who know they should be dieting and exercising, but they don't do it. We need to find ways to help them."

For more information:

U-M Health Topics A-Z: Aspirin and Heart Disease
http://www.med.umich.edu/1libr/aha/aha_aspheart_car.htm

U-M Health Topics A-Z: Preventing Heart Disease
http://www.med.umich.edu/1libr/aha/aha_hrtcom_sha.htm

U-M Health Topics A-Z: Prevenion de enfermedades cardiacas http://www.med.umich.edu/1libr/aha/aha_hrtcom_spa.htm

University of Michigan Cardiovascular Center
http://www.med.umich.edu/cvc/about/ababoa.htm