Low-dose aspirin prevents cognitive decline in women with high cardiovascular risk

Aspirin for primary prevention of cardiovascular disease is controversial (meaning there is conflicting evidence for its use by patients who have not previously suffered a heart attack or stroke). But the authors of a study just published in BMJ Open (British Medical Journal) show that low-dose aspirin prevented cognitive decline in women with high cardiovascular risk. They set out to...

"...examine whether low-dose acetylsalicylic acid (ASA) influences the rate of cognitive change in elderly women..."

...by examining cognitive decline and dementia incidence for 681 women aged 70–92 years derived from the Prospective Population Study of Women and from the H70 Birth Cohort Study in Gothenburg, Sweden. (They excluded individuals with dementia and users of warfarin, clopidogrel or heparin.) 95.4% (N=601) of their subjects had a high cardiovascular risk (CVD), defined as 10% or higher 10-year risk of any cardiovscular disease event according to the Framingham heart study. 129 of them used low-dose aspirin (75–160 mg daily) at baseline. 5 years later they performed a follow-up on 489 women. Cognition was measured using the Mini Mental State Examination (MMSE), word fluency, naming ability and memory word tests. Dementia was diagnosed according to the DSM-III-R. They also noted any incidence of stroke and peptic ulcer. Aspirin did indeed slow the rate of cognitive decline:

"Women on regular low-dose ASA declined less on MMSE at follow-up than those not on ASA. This difference was even more pronounced in those who had ASA at both examinations (p=0.004 compared with never users; n=66 vs n=338). All other cognitive tests showed the same trends. There were no differences between the groups regarding short-term risk for dementia (N=41)."

Note that the greatest benefit was shown for women who were already using aspirin at the beginning of the study, suggesting that longer use conferred more protection. The authors conclude:

"Low-dose ASA treatment may have a neuroprotective effect in elderly women at high cardiovascular risk."

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