Wednesday, 24 July 2019 21:57

New research warns against taking aspirin unless recommended by a provider

Written by Dr. Daliah Wachs
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Harvard researchers warn that 30 million Americans are taking aspirin for prevention of heart disease when they could be putting themselves at risk for other serious diseases.

They estimate that 1/5 of these individuals took aspirin on their own without a doctor’s order.

Although aspirin use is recommended for secondary prevention of future heart attacks and ischemic stroke in those at risk of having a future episode, primary prevention (in those who have never had an attack) is still debated.

One study last year found minimal benefit if at all for primary prevention in low risk individuals.  Many experts say the risk of gastrointestinal bleeding, heart disease, hemorrhagic stroke and kidney disease outweigh the benefits.

The latest guidelines from the American College of Cardiology states the following in terms of aspirin for prevention of heart disease:

FOR DECADES, LOW-DOSE ASPIRIN (75-100 MG WITH US 81 MG/DAY) HAS BEEN WIDELY ADMINISTERED FOR ASCVD PREVENTION. BY IRREVERSIBLY INHIBITING PLATELET FUNCTION, ASPIRIN REDUCES RISK OF ATHEROTHROMBOSIS BUT AT THE RISK OF BLEEDING, PARTICULARLY IN THE GASTROINTESTINAL (GI) TRACT. ASPIRIN IS WELL ESTABLISHED FOR SECONDARY PREVENTION OF ASCVD AND IS WIDELY RECOMMENDED FOR THIS INDICATION, BUT RECENT STUDIES HAVE SHOWN THAT IN THE MODERN ERA, ASPIRIN SHOULD NOT BE USED IN THE ROUTINE PRIMARY PREVENTION OF ASCVD DUE TO LACK OF NET BENEFIT. MOST IMPORTANT IS TO AVOID ASPIRIN IN PERSONS WITH INCREASED RISK OF BLEEDING INCLUDING A HISTORY OF GI BLEEDING OR PEPTIC ULCER DISEASE, BLEEDING FROM OTHER SITES, AGE >70 YEARS, THROMBOCYTOPENIA, COAGULOPATHY, CHRONIC KIDNEY DISEASE, AND CONCURRENT USE OF NONSTEROIDAL ANTI-INFLAMMATORY DRUGS, STEROIDS, AND ANTICOAGULANTS. THE FOLLOWING ARE RECOMMENDATIONS BASED ON META-ANALYSIS AND THREE RECENT TRIALS:
  • LOW-DOSE ASPIRIN MIGHT BE CONSIDERED FOR PRIMARY PREVENTION OF ASCVD IN SELECT HIGHER ASCVD ADULTS AGED 40-70 YEARS WHO ARE NOT AT INCREASED BLEEDING RISK.
  • LOW-DOSE ASPIRIN SHOULD NOT BE ADMINISTERED ON A ROUTINE BASIS FOR PRIMARY PREVENTION OF ASCVD AMONG ADULTS >70 YEARS.
  • LOW-DOSE ASPIRIN SHOULD NOT BE ADMINISTERED FOR PRIMARY PREVENTION AMONG ADULTS AT ANY AGE WHO ARE AT INCREASED BLEEDING RISK.

A report published in the American Heart Association’s Heart and Stroke Statistics annual report cited 48% of US adults have some type of cardiovascular disease.

The uptick could be due to rising obesity, and lowering thresholds for diagnosing guidelines such as high blood pressure (now considered high if over 130/80).

Although smoking rates have declined over the years, many still use tobacco and recent research has found E-cigs to increase risk of heart attack and stroke by 70%.

 What is a stroke?

A stroke occurs when an area of the brain does not get the proper oxygen and blood flow it needs. There are two major types of stroke:  ischemic and hemorrhagic.

Ischemic strokes are more common than the latter and occur when a clot prevents blood flow to part of the brain.  80% of all strokes fall under ischemic.  It is likened to a heart attack, except the brain tissue is being deprived of blood and nutrients.  Plaques commonly arise from arteriosclerosis that break off travel to the smaller vessels of the brain.

Hemorrhagic strokes are less common and occur when there is a bleed of one of the brain vessels.  The bleed prevents blood flow into the brain since it is seeping outside the brain tissue, causing damage to nearby cells.  The bleeds could occur from high blood pressure or aneurysms that rupture.

 What are the signs of a stroke?

Since a clot or bleed usually affect one area of the brain, we see symptoms on one side of the body, many times its contralateral (opposite) side.  We can also see central effects.  The symptoms of stroke include the following:

  • Weakness of one side of the body
  • Loss of balance
  • Numbness on one side of the body
  • Slurred speech
  • Vision issues
  • Headache
  • Facial droop

and more…..

 How are strokes treated?

If the stroke was caused by a clot (ischemic) immediate treatment includes dissolving/removing the clot.   Aspirin is used initially and if within the proper time frame, tissue plasminogen activator (TPA).  These clots can also be surgically removed and arteries widened to bring blood flow to the brain.

With a hemorrhagic  stroke, we need to stop the bleeding and improve flow to the brain.  Controlling the bleed, bypassing the vessel, “clogging” the aneurysm with techniques such as “coiling” (endovascular embolization) are sometimes utilized.

Time is of the essence, so it's crucial to identify the warning signs and call 911 immediately.  The American Stroke Association uses the acronym “FAST” (Facial drooping, Arm weakness, Speech difficulty, and Time to call 911).  The sooner a stroke victim receives medical attention the better the prognosis.

What are the risk factors for stroke?

The following put us at risk of having a stroke.

  • High blood pressure
  • Family history of stroke
  • Diabetes
  • Cardiovascular disease (artery clogging, such as the heart and carotid arteries)
  • Abnormal heart rhythms, such as atrial fibrillation
  • Smoking
  • Drugs
  • Obesity
  • Inactivity
  • Clotting disorder
  • Sleep apnea
  • Being older (greater than 55)
  • African-Americans appear to be more at risk than Caucasians and Hispanics
  • Men seem to be more affected than women

 How do we prevent strokes?

Avoid the following:

  • Excessive drinking
  • Drug use
  • Tobacco products
  • Control blood pressure, sugar and cholesterol
  • Get evaluated by a medical provider if at risk for heart disease or stroke. 

Preventing Heart Disease

Firstly, we must know our risk factors. These include:

  • Family history of heart disease
  • Personal history of heart disease
  • High Blood Pressure
  • High Cholesterol
  • Diabetes
  • Smoking
  • Obesity
  • Inactivity
  • Males over 40
  • Females who are post menopausal
  • High stress

and even short stature has been cited as a potential risk factor.

As you can see, many of us can be at risk for heart disease.  Therefore, secondly, we should be evaluated with an EKG, echocardiogram and any other exams our medical provider and/or cardiologist deem necessary.

 

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, are her own. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

Last modified on Wednesday, 24 July 2019 22:03