Iron, Aspirin, and Heart Disease Risk

Abstract

To the Editor.— Several studies during the past three decades have examined the effects of long-term aspirin use on heart disease risk. 1 Definite proof that aspirin lowers risk has been elusive. Protective effects are often found but are rarely statistically significant. As a working hypothesis, it has been widely supposed that aspirin might confer protection against heart disease through its antithrombotic action in coronary arteries. A recent hypothesis 2 on iron and the sex difference in heart disease risk suggests an alternative mechanism by which long-term aspirin use might reduce cardiovascular risk. The hypothesis is that the greater risk of heart disease in men and postmenopausal women in affluent societies in comparison with premenopausal women results from their higher levels of stored iron. Hysterectomy increases cardiovascular risk in young women whether or not the ovaries are removed. 3,4 One interpretation is that cessation of menstrual blood loss alone is