| While
it's been awhile since we presented a preventive medicine topic for the
reader, an abundance of information exists from various other
sources - print, telecast, Internet, etc. Some of it
is pretty good. What follows is an update we hope you can take to
heart (pun intended) while having some fun.
All of us
appreciate the role of aspirin in prevention of serious vascular
illness. Or do we? Recent research indicates we may be
better served to use it more selectively, especially when the FDA can
seem to find a reason to pull about any drug off the market.
Results from the Women's Health Study (focusing on aspirin use for
primary prevention of heart disease) indicate that low-dose aspirin did
not significantly reduce the risk of a first heart attack (MI) in
younger women. It did, however, reduce the risk of stroke.
In women 65 and older, it was still effective for both. Age alone
can't serve as the criterion to start aspirin, owing to allergy,
interactions with other drugs, or risks of bleeding. Men are at
greater risk for MI's than strokes - they have 40% more of
the former than the latter. Aspirin is effective prevention for
them, principally against MI. Women, on the other hand, have 10%
more strokes than MI's.
If we can
define the population a little better, we can determine who benefits the
most from aspirin primary prevention therapy. ("Primary"
means first attack; the recommendations for those who have already had
an event have not changed.) That's where the fun begins, if you
are Internet-savvy. The following web site is a resource for you
to determine your risk of having a heart attack in the next 10 years:
http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm
Click on the
"10-year Risk Calculator for Patients." American Heart
Association guidelines recommend aspirin 75 to 162 mg daily (a baby
aspirin up to half a regular aspirin) for women who have a risk greater
than 20%. This includes those with pre-existing heart disease,
cerebrovascular disease, and/or diabetes. Women in the 10 to 20%
profile are at intermediate risk, and aspirin should be considered,
weighing its risk of gastric bleeding against the benefits, all the
while keeping blood pressure under control. Those with a risk
below 10% are not advised to take aspirin.
If you plug
your personal data in the calculator, you can see where you stand
now. The fun, and the learning, takes place when you insert
hypotheticals (e.g. lower total cholesterol or blood pressure, raise HDL,
stop smoking, change your gender (just kidding!). Maybe, just
maybe, this playing on the computer will be the motivation factor for
you. |
