Revised Aspirin Therapy Guidelines

< Mar. 18, 2009 > --  US experts have revised aspirin guidelines, stating that lower doses appear to be at least as effective as higher doses and safer at preventing heart attack in men and stroke in women.

Whether to take daily aspirin to fight heart disease has been a long-standing debate. In light of the increased risks for gastrointestinal bleeding in some, the debate questions who should take aspirin and at what dose

People taking the clot-dissolving drug clopidogrel (Plavix®) are of particular concern.   

New Aspirin Guidelines  

The new US  Preventive Services Task Force guidelines are tailored to match age and gender. Among the recommendations: Men aged 45 to 79 should take aspirin if the chances of preventing a heart attack outweigh the chances of gastrointestinal bleeding (GI). Women aged 55 to 79 should take the drug if the chances of reducing ischemic stroke outweigh the risks of GI bleeding.

"Subsequent to the 2002 recommendations, there was more information that came out of the Women's Health Initiative, specifically, that enabled us to look at this recommendation by gender," says Dr. Michael LeFevre, a task force member and professor of family and community medicine at the University of Missouri, Columbia. As a result, "We have a recommendation for men and a recommendation for women. We did not have that before." 

Dr. LeFevre, adds that aspirin seems to be more effective in men for preventing heart attack but, in women, better at preventing stroke. 

Balancing the Benefits and Risks 

In addition, Dr. Carl J. Lavie, medical director of cardiac rehabilitation at the Ochsner Heart and Vascular Institute in New Orleans, says, "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 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 is not clear whether patients aged 80 and older should take aspirin. 

Dose Recommendations Reaffirmed 

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. 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.

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

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

Always consult your physician for more information.

What is Angina Pectoris?

Angina pectoris (or simply angina) is recurring chest pain or discomfort that happens when some part of the heart does not receive enough blood and oxygen.

Angina is a symptom of coronary heart disease (CHD), which occurs when arteries that carry blood to the heart become narrowed and blocked due to atherosclerosis or a blood clot.

Angina pectoris occurs when the heart muscle (myocardium) does not receive an adequate amount of blood and oxygen needed for a given level of work (insufficient blood supply is called ischemia).

Each individual may experience symptoms differently. However, the most common symptoms of angina are a pressing, squeezing, or crushing pain. This pain is usually in the chest under the breast bone. Pain may also occur in the upper back, both arms, neck, or ear lobes 

In some cases, pain may radiate into the arms, shoulder, jaw, neck, and/or back. Shortness of breath, weakness, and or/fatigue may also occur.

The chest pain associated with angina usually begins with physical exertion. Other triggers include emotional stress, extreme cold and heat, heavy meals, excessive alcohol consumption, and cigarette smoking. Angina chest pain is usually relieved within a few minutes by resting or by taking prescribed cardiac medications.

An episode of angina does not indicate that a heart attack is occurring, or that a heart attack is about to occur. Angina does indicate, however, that coronary heart disease is present and that some part of the heart is not receiving an adequate blood supply. However, persons with angina have an increased risk of heart attack.

A person who has angina should note the patterns of his/her symptoms - what causes the chest pain, what it feels like, how long episodes usually last, and whether medication relieves the pain. Call for medical assistance if the angina episode symptoms change sharply.

In addition to a complete medical history and medical examination, a physician can often diagnose angina pectoris by noting the patient's symptoms and how/when they occur. Certain diagnostic procedures may also determine the severity of the coronary heart disease, and may include:

• electrocardiogram (ECG or EKG) - a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.
• stress test  - A test that is given while a patient walks on a treadmill or pedals a stationary bicycle to monitor the heart during exercise. Breathing and blood pressure rates are also monitored. A stress test may be used to detect coronary artery disease, and/or to determine safe levels of exercise following a heart attack or heart surgery.
• cardiac catheterization -
  With this procedure, x-rays are taken after a contrast agent is injected into an artery to locate the narrowing, occlusions, and other abnormalities of specific arteries. 

Specific treatment for angina pectoris will be determined by the physician based on your age, overall health, medical history, and extent of the disease. Additionally, your tolerance for specific medications, procedures, or therapies. 

Medications may be prescribed for people with angina. The most common is nitroglycerin which helps to relieve pain by widening the blood vessels. This allows more blood flow to the heart muscle and decreases the workload of the heart.

The symptoms of angina pectoris may resemble other medical conditions or problems. As such, it is important to consult your physician about your symptoms.

Always consult your physician for more information.