Heart Disease

Daily Aspirin – Yes or No?

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Aspirin: FDA Says ‘No’ Others Say ‘Yes’.

I found this article quite helpful in my own decision regarding whether or not to continue my daily aspirin 81 mg dose.

The bump I gave myself on the shin a few weeks ago that bled profusely and took hours to clot was also quite helpful in my decision regarding whether or not to continue my daily aspirin 81 mg dose. 

Update 06.06.14

Check out the following link.  If you’re an older male you might find this of interest.

http://www.webmd.com/erectile-dysfunction/news/20110303/regular-use-of-painkillers-linked-to-ed

Update 07.26.14

This link takes you to the 2012 Circulation article.

Aspirin.

Update 08.04.14

More links for your reading and research pleasure.

Aspirin May Not Protect Against Cardiovascular Disease – Prevention.com.

Benefits of aspirin more modest than previously believed — St George’s, University of London.

Researchers from Professor Kausik Ray’s group at St George’s, University of London investigated the drug’s effectiveness in primary prevention and the prevalence of side effects. They also assessed if aspirin had any impact on the risk of death from cancer among people considered at risk of cardiovascular disease.

They analysed data from nine clinical trials involving over 100,000 participants without a history of cardiovascular disease. Half of the participants took aspirin and half took a placebo. The average participant in the aspirin arm of these trials took aspirin for about six years.

The researchers found that although aspirin in conventional daily or alternate day doses reduced the risk of total cardiovascular disease events by 10 per cent, this was largely due to a reduction in non-fatal heart attacks. It did not include a reduction in other cardiovascular disease events including death from heart attack, or fatal or non-fatal stroke.

The study also showed that this benefit was almost entirely offset by a 30 per cent increase in risk of life-threatening or debilitating internal bleeding events. This means that while one cardiovascular disease event was averted for every 120 people treated with aspirin for about six years, one in 73 people suffered from potentially significant bleeding during the same period.

Testosterone Treatment and MI Risk

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Filling a prescription for testosterone therapy was associated with a greater risk of having a nonfatal myocardial infarction (MI) in the next 3 months, a large observational study showed.

The risk after a prescription was filled was more than doubled in men 65 and older overall compared with that in the year before the prescription (rate ratio 2.19, 95% CI 1.27-3.77), according to Robert Hoover, MD, ScD, of the National Cancer Institute in Bethesda, Md., and colleagues.

The study was limited, however, by the observational design, the use of administrative data that lacked information on indications for treatment, and the inclusion of nonfatal MIs only.

via Study Feeds Concerns About MI Risk With Testosterone Tx.

Cardiologists Should Mind Radiation Doses, ESC Says

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Because radiation used in imaging tests is proven to cause cancer, they wrote, “cardiologists should make every effort to give ‘the right imaging exam, with the right dose, to the right patient.’

via Cardiologists Should Mind Radiation Doses, ESC Says.

We are seeing more applicant/patient initiated cardiac scans.  I recently became aware of a life insurance application where the underwriter requested a repeat cardiac CT scan.  The applicant’s cardiologist flatly rejected this course of action in an a asymptomatic patient with a correspondingly low CHD risk score.

Now you understand the cardiologist’s thinking.

Did I hear someone say “litigation risk”?

Testosterone Treatment Tied to Worse Cardiac Outcomes

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After adjustment for the presence of coronary artery disease, testosterone therapy was associated with a greater risk of all-cause mortality, myocardial infarction, and ischemic stroke 3 years after angiography (25.7% versus 19.9%; HR 1.29, 95% CI 1.04-1.58), according to P. Michael Ho, MD, PhD, of the Department of Veterans Affairs (VA) Eastern Colorado Health Care System in Denver, and colleagues.

via Testosterone Tx Tied to Worse Cardiac Outcomes.

How come the television commercials don’t tell you this information when they try to make you think you have a disease called Low T?

Annual prescriptions for testosterone increased more than five-fold from 2000 to 2011. In 2011, the total number of prescriptions numbered 5.3 million and make up a market of 1.6 billion, the authors wrote.

Never mind.

Calcium Score Beats Lipids for Telling CVD Risk

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Measurement of coronary artery calcium stratified patient risk for cardiovascular disease regardless of dyslipidemia burden or definition, researchers found.

When measured across lipid abnormality categories, patients with a coronary artery calcium score of 100 or more had a 22.2 to 29.2 incidents of cardiovascular disease per 1,000 person-years versus 2.4 to 6.2 events per 1,000 person-years among those with arterial calcium scores of 0, according to Khurram Nasir, MD, MPH, of Baptist Health South Florida in Miami Beach, and colleagues.

via Calcium Score Beats Lipids for Telling CVD Risk.

Race Has Role in Vitamin D Link to Heart Risk

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A 10-ng/mL decrease in 25(OH)D levels was associated with an increased risk of coronary heart disease events in whites (HR 1.26, 95% CI 1.06-1.49) and those with Chinese ancestry (HR 1.67, 95% CI 1.07-2.61), according to Ian de Boer, MD, of the University of Washington in Seattle, and colleagues.

But a similar relationship was not seen among blacks (HR 0.93, 95% CI 0.73-1.20) and Hispanics (HR 1.01, 95% CI 0.77-1.33), the investigators reported in the July 10 issue of the Journal of the American Medical Association.

via Race Has Role in Vitamin D Link to Heart Risk.

A couple of years ago I asked my primary care physician to check my Vitamin D level.  We were both surprised to discover the fact I was Vitamin D deficient.  Since then I’ve been on daily Vitamin D supplementation of 5000iu.

Simple blood test.  Just do it.

The researchers advised caution in interpreting the results in the Chinese and Hispanic participants because of the low sample sizes.

I’m still going to take my supplement.

Large Study Affirms Safety of Statins

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The study included information from 135 randomized trials — 55 with a placebo control and 80 with an active comparator — that included a total of 246,955 participants with or without cardiovascular disease. The study initially included trials of atorvastatin, fluvastatin, simvastatin, lovastatin, pravastatin, and rosuvastatin (Crestor); trials of pitavastatin (Livalo) were added post hoc because the protocol was already being finalized at the time the drug was approved.

via Large Study Affirms Safety of Statins.

Afib Linked to Silent Stroke

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MRI indicated silent cerebral ischemia lesions in 89% patients with paroxysmal Afib and 92% with persistent Afib compared with 46% of controls, which wasn’t significantly different between the two types of Afib but was for both versus controls (P<0.01).

The number of these lesions averaged 41 in persistent Afib, 33 in paroxysmal Afib, and 12 in controls, which was significantly different for all three groups.

The high prevalence of these lesions in the control group compared with what has been reported in the general population may have reflected the moderate to high cardiovascular risk among these patients referred for cardiovascular prevention or treatment, the researchers suggested.

The lesions can have either ischemic and embolic origins, but the peculiar “spotted” distribution of “small sharply demarcated lesions, often in cluster, with bilateral distribution, prevalently in the frontal lobe” seen in 50% and 67% of the paroxysmal and persistent Afib patients, respectively, strongly supported an embolic mechanism, they noted.

via Afib Linked to Silent Stroke.

If these findings are replicated in future studies, the question for underwriters is should any Afib risk be Standard mortality?

PTSD May Raise Risk of Heart Disease

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Through a median of 13 years of follow-up, twins who had PTSD at baseline had a significantly higher rate of incident coronary heart disease compared with those without PTSD (22.6% versus 8.9%), according to Viola Vaccarino, MD, PhD, of Emory University in Atlanta, and colleagues.

The difference was not due to established risk factors, since the association remained significant after adjustment for sociodemographic factors, service in Southeast Asia, lifestyle factors, coronary heart disease risk factors, major depression, and other psychiatric diagnoses (OR 2.1, 95% CI 1.1-3.9), the researchers reported online in the Journal of the American College of Cardiology.

via PTSD May Raise Risk of Heart Disease.