Revised guidelines on daily aspirin for your heart

I read an article in Health news that reinforced what my Doctor has been telling me for years.

Who should take an aspirin each day to fight heart disease, and at what dose? The latest guidelines say that lower doses are as effective as higher doses and safer at preventing heart attack and stroke.

The new U.S. Preventive Services Task Force guidelines match age and gender. Aspirin seems to be more effective in men for preventing heart attack but, in women, better at preventing stroke.

Dr. Carl J. Lavie, medical director of cardiac rehabilitation at the Ochsner Heart and Vascular Institute in New Orleans, added: "The benefits of aspirin use always have to be balanced against the risks. If a patient has low risk of events in the near future, aspirin should not be prescribed. If the risk is very high, clearly aspirin is needed."

The recommendations, published in the March 17 issue of the Annals of Internal Medicine, state:

Men aged 45 to 79 with heart risk factors should take aspirin if the preventive benefits outweigh the risk of bleeding.

At-risk women aged 55 to 79 should take aspirin if the odds of reducing a first ischemic stroke outweigh the chance of bleeding.

Men under the age of 45 and women under 55 who have never had a heart attack or stroke should not take aspirin for prevention.

At this time, it isn't clear whether patients aged 80 and older should take aspirin.

The task force emphasized that the recommendations only apply to people who have never had a heart attack or stroke.

The last task force recommendations came out in 2002. At the time, the panel acknowledged that the evidence for the use of aspirin in preventing heart problems was still evolving.

A second paper in the same issue of the journal reaffirms the task force guidelines, finding that lower doses of daily aspirin (75 milligrams to 81 milligrams) are equally, if not more effective, than higher doses (100 mg or more) in preventing heart attack and stroke in at-risk individuals

The paper also found that high doses may actually do more harm, especially in people taking Plavix.

According to background information in the study, aspirin is the most used drug worldwide to prevent heart attack and stroke. More than one-third of U.S. adults are believed to take aspirin each day.

"All these trials put together really favor taking lower doses of aspirin," said Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York City.

Latest Tips & Tricks To Protect Your Heart

Did you see the article in the New York Times Health Section on how to protect your heart? I was familiar with no smoking, low cholesterol and blood pressure, regular exercise and weight loss control. There were some new suggestions that caught my eye though.

As we learn more through research and why heart attacks happen, some of the ways to avoid them is different than it used to be. As an example diet and exercise controls are not as strict. The food tastes better, is cheaper and you don’t have to drown in a pool of sweat to get the benefits of exercise.

The risk factors have not changed though. Heredity, genetics, high cholesterol and blood pressure, smoking, diabetes, belly fat, and our sedentary lifestyles all play a part. There is a newer factor that is becoming recognized as even more important as a cause of heart attacks and that is C-reactive protein, or CRP.

It is a marker in the blood that is concerned with inflammation that, along with coagulation factors, is now increasingly recognized as the driving force behind clots that block blood flow to the heart.

Even if your cholesterol is normal, your risk of heart attack goes up if the CRP is elevated. Some doctors are starting to believe that when people have their cholesterol checked, they should also be tested for high-sensitivity CRP.

The new advice on what to eat actually was known before we were told to eat a low-fat diet. Doctors knew as far back as 1958 that heart disease was rare in the Mediterranean and Asian regions where vegetables, grains, fruits, beans and fish were the dietary the usual foods. The US diet on the other hand is filled with red meat, cheese and other foods rich in saturated fats, heart disease and cardiac deaths were epidemic.

What was missed at the time and has now become increasingly apparent is that the heart-healthy Mediterranean diet is not really low in fat, but its main sources of fat olive oil and oily fish as well as nuts, seeds and certain vegetables help to prevent heart disease by improving cholesterol ratios and reducing inflammation.

One study in 1999 on the value of a traditional Mediterranean diet found that within four years, the Mediterranean approach reduced the rates of heart disease recurrence and cardiac death by 50 to 70 percent when compared with the heart association diet. Several subsequent studies have confirmed the same approach to diet.

More than 90% of the people who try the Mediterranean diet stick to it. The food tastes great and you can buy it in any grocery store.

Some of the foods that help to reduce the inflammatory marker CRP are cold-water fish like salmon, tuna and mackerel; flax seed; walnuts; and canola oil and margarine based on canola oil. Fish oil capsules are also an effective supplement. Another good tip is to try cooking with canola oil and using more expensive and aromatic olive oil for salads.

Vegetables, fruits and red wine (or purple grape juice) are helpful also because the antioxidants help prevent LDL cholesterol from forming in the arteries.

Something else to consider is a link between periodontal disease and increased risk of heart disease, most likely because gum disease causes low-grade chronic inflammation. So good dental hygiene, and regular periodontal cleanings, can help protect your heart as well as your teeth.

Reducing chronic stress is another important factor. A study of the effects of stress in more than 27,000 people, found that stress more than doubled the risk of heart attacks.

So remember not to sweat the small stuff, and it’s ALL small stuff. And getting enough sleep improves the ability to manage stress. Take a deep breath and relax or try meditation, prayer, yoga, self-hypnosis, laughter, taking a midday nap, getting a dog or cat, taking up a hobby and exercising regularly.

A final note on exercising. Did you know that a 1996 study found that just 15 minutes of exercise five days a week decreased the risk of cardiac death by 46 percent. A current British study published in the American Journal of Clinical Nutrition found that building up short brisk three minute walks for a total of 30 minutes a day did as much cardiac good as one continuous 30-minute session.

Is A Daily Aspirin Helpful For Reducing Heart Attack

I have recently seen a number of articles on Aspirin that seem to go against what I thought I knew. A new trial finds that aspirin does not reduce the risk of heart attack and stroke for people with diabetes or peripheral arterial disease.

If you have already had a heart attack, or stroke however, Aspirin clearly is effective in secondary prevention, said study author Dr. Jill Belch, a professor of vascular medicine at the University of Dundee in Scotland. Her report was published in the online issue of the BMJ.

People who had not yet suffered a heart attack or stroke but were at high risk because they had diabetes or peripheral arterial disease (partial blockage of leg arteries), did not benefit from daily aspirin.

Advertisements urging people to take aspirin to benefit the heart are accurate for those who already have had an event, both Belch and Hiatt said.

"It works if you've already had a heart attack," Belch said. "But there is no proof for primary prevention, no proof at all."

"The evidence is solid that aspirin should be given to people with known heart disease, but the evidence for people who have risk factors for heart disease is different." said Dr. William R. Hiatt, a professor of medicine at the University of Colorado, who wrote an accompanying editorial.

Before I had a heart attack, I had a recommendation from the American Heart Association and my family Doctor to take an 81mg. aspirin daily because of a family history of heart attacks and diabetes.

There are some who think that in the future the recommendation may change, but until it does, I think I am glad that I erred on the side of caution, and took my morning aspirin. I still believe it may have helped in lessening the effects when I had my event, and I am convinced that it is right for my situation.

Risks and possible benefits of aspirin for the heart are reviewed by the U.S. Food and Drug Administration.