Daily Aspirin Can Bring Heart Benefits for Some People, But Risks Too

For people who have both type 2 diabetes and heart failure, new research offers a mixed message on taking a daily low-dose aspirin.

The study found the daily pill can reduce the risk for heart failure-related hospitalization and death in people who have both conditions. However, it also found that a daily aspirin raises their risk for nonfatal heart attack and stroke.

The findings came from the analysis of data from more than 12,000 residents of the United Kingdom, 55 and older. They all had heart failure and type 2 diabetes, but no history of heart attack, stroke, peripheral artery disease or the heart rhythm disorder atrial fibrillation.

During a five-year span, those who took a low-dose aspirin a day were 10 percent less likely to have been hospitalized or to have died because of heart failure than those who did not. But they were 50 percent more likely to have had a nonfatal heart attack or stroke.

Aspirin is a blood thinner that reduces the risk for blood clots. Both heart failure and diabetes increase the risk for blood clots that can lead to heart attack and stroke. About 27 million people in the United States have type 2 diabetes, and about 6.5 million U.S. adults have heart failure, the researchers said.

Though a low-dose daily aspirin is recommended for people who’ve had a heart attack or stroke, its use as a preventive treatment in people with heart risk factors but no history of heart attack or stroke is unclear, according to the study authors.

The findings are to be presented at a meeting of the American College of Cardiology, in Orlando, Fla.

Some studies have even suggested that daily aspirin might be harmful for people with heart failure, the researchers noted.

Lead author Dr. Charbel Abi Khalil said his team was surprised to find that taking a low-dose daily aspirin increased the risk for nonfatal heart attack and stroke among the study participants.

“This finding might be due to the fact that those patients lived longer,” he said in a meeting news release. “Given their mean age of 70 years, perhaps these patients were predisposed to more cardiac events.”

Abi Khalil is an assistant professor of medicine at Weill Cornell Medicine in Qatar.

He urged people to talk with their doctors to assess the possible benefits and risks of taking a daily aspirin.

Source: HealthDay

Today’s Comic


Both Lacto-ovo-vegetarian and Mediterranean Diets Are Good for Your Heart

A lacto-ovo-vegetarian diet, which includes eggs and dairy but excludes meat and fish, and a Mediterranean diet are likely equally effective in reducing the risk of heart disease and stroke, according to new research in the American Heart Association’s journal Circulation.

Previous separate studies have shown that a Mediterranean diet reduces certain risk factors for cardiovascular disease, as does a vegetarian diet; however, this was the first study to compare effects of the two distinct eating patterns

Current study authors said they wanted to evaluate whether switching to a lacto-ovo-vegetarian diet would also be heart-healthy in people who were used to eating both meat and fish. “To best evaluate this issue, we decided to compare a lacto-ovo-vegetarian diet with a Mediterranean diet in the same group of people,” said Francesco Sofi, M.D., Ph.D, lead study author and professor of clinical nutrition at the University of Florence and Careggi University Hospital in Italy.

The study included 107 healthy but overweight participants, ages 18-75, who were randomly assigned to follow for three months either a low-calorie vegetarian diet, which included dairy and eggs, or a low-calorie Mediterranean diet for three months. The Mediterranean diet included poultry, fish and some red meat as well as fruits, vegetables, beans and whole grains. After three months, the participants switched diets. Most participants were able to stay on both diets.

Researchers found participants on either diet:

  • lost about 3 pounds of body fat;
  • lost about 4 pounds of weight overall; and
  • experienced about the same change in body mass index, a measure of weight in relationship to height.

Authors said they did find two differences between the diets that may be noteworthy. The vegetarian diet was more effective at reducing LDL (the “bad”) cholesterol, while the Mediterranean diet resulted greater reductions in triglycerides, high levels of which increase the risk for heart attack and stroke.

Still, “the take-home message of our study is that a low-calorie lacto-ovo-vegetarian diet can help patients reduce cardiovascular risk about the same as a low-calorie Mediterranean diet,” Sofi said. “People have more than one choice for a heart-healthy diet.”

In an editorial accompanying the study, Cheryl A. M. Anderson, Ph.D., M.P.H., M.S., an associate professor of preventive medicine at the University of California, San Diego, in California, wrote that there were similarities between the two diets that may explain the results. Both follow “a healthy dietary pattern rich in fruits and vegetables, legumes [beans], whole grains and nuts; focusing on diet variety, nutrient density and appropriate amount of food; and limiting energy intake from saturated fats.”

Anderson, who was not involved in the study, added that promoting both diets by healthcare professionals “offer a possible solution to the ongoing challenges to prevent and manage obesity and cardiovascular diseases.”

Study limitations include the fact that participants were at “relatively low” risk of cardiovascular disease. Anderson said future research should compare the diets in patients at higher risk for heart disease and should also explore “whether or not healthful versions of traditional diets around the world that emphasize fresh foods and limit sugars, saturated fats, and sodium can prevent and manage obesity and cardiovascular diseases.”

Source: American Heart Association

Today’s Comic

Women Suffering Heart Attack Called SCAD May Fare Better with Conservative Care

Traci Klein wrote . . . . . . .

Patients who suffer from a type of heart attack that affects mainly younger women, called spontaneous coronary artery dissection or SCAD, may benefit most from conservative treatment, letting the body heal on its own. This is according to a new scientific statement by a Mayo Clinic led team, published by the American Heart Association in its journal, Circulation.

Most heart attacks occur when plaque builds up in arteries over a lifetime. The plaque ruptures, causing a blockage and a heart attack. In SCAD, a tear occurs inside an artery, and that can cause a blockage, leading to a heart attack.

“It may seem counterintuitive, but we discovered that treating SCAD the same way we treat heart attacks due to atherosclerosis can cause further tearing and damage to the vessel,” says Sharonne Hayes, M.D., chair of the writing group for the new scientific statement and a Mayo Clinic cardiologist who founded its Women’s Heart Clinic. “But the initial proper diagnosis is critical in guiding the care.”

The statement is an overview of what an international group of experts know about SCAD, including:

  • Risk factors
  • Its high rate of post SCAD chest pain and recurrence
  • Its association with women, pregnancy, and physical and emotional stress triggers
  • Its connection to other diseases of the arteries, such as fibromuscular dysplasia
  • The best diagnosis and treatment recommendations based on new evidence and experts’ care of SCAD patients

Until 2010, little was understood about SCAD, which had been described as a rare and universally fatal cause of acute coronary syndrome, heart attack and sudden cardiac arrest in women during and shortly after pregnancy.

Over the past several years research has refuted these misunderstandings. Increased understanding of SCAD, availability of intravascular imaging techniques, development of SCAD specific angiographic classification, increased awareness among providers, and efforts by SCAD patients using social media suggest that SCAD is much more common than previously thought, especially in young women.

The average age of women with SCAD ranges from 45 to 53 years. SCAD occurs overwhelmingly in women, and among individuals who have few conventional cardiovascular risk factors, such as high blood pressure, unhealthy cholesterol levels or smoking, the statement says.

“Even with what we have learned over the past several years, SCAD continues to be misdiagnosed and underdiagnosed,” Dr. Hayes says. “And we know it is not rare. It is the No. 1 cause of heart attack during pregnancy and in the period right after giving birth, and the No. 1 cause of heart attack in women under age 50.”

Misdiagnoses often happen because of a low suspicion of heart attack in younger women who do not have typical heart disease risk factors but arrive at an emergency room with classical heart attack symptoms, such as discomfort in the chest and the upper body, shortness of breath, nausea and light-headedness, Dr. Hayes says. Misdiagnoses also can happen if the patient is sent to the catheterization lab, where stents are often used to open blocked arteries. The statement provides expert consensus to help health care providers know how to best treat SCAD patients.

The statement shows that, in most patients who did not receive stents, the dissections healed on their own within weeks and months. For some, the healing began within days, Dr. Hayes says.

The statement also emphasizes the importance of tailored cardiac rehabilitation programs for SCAD patients. In addition, addressing mental health is critical, the authors say. “Anxiety and depression are common in SCAD survivors, and they often are being treated by health care providers who have little familiarity of the disease or in providing psychosocial support,” Dr. Hayes says. “We’ve found that online support groups can be immensely helpful in addition to finding a care team that is responsive to patients’ concerns,” she says.

The cause of SCAD is believed to be a combination of factors, including diseases of the arteries, genetic factors, hormonal influences and, less commonly, connective tissue diseases. These factors can be compounded by environmental stressors.

The statement points to persistent gaps in knowledge of SCAD. Only recently have there been limited prospective studies, and most available data are retrospective and observational. Larger-scale prospective and epidemiological studies are needed to understand the disease and improve treatment, Dr. Hayes says.

Source: Mayo Clinic

Watch video on YouTube:

Mayo Clinic Minute: What is spontaneous coronary artery dissection? . . . . .

Today’s Comic

FDA Warns Long-term Risks with Antibiotic Clarithromycin (Biaxin) in Heart Disease Patients

The antibiotic clarithromycin (brand name: Biaxin) may increase the long-term risk of heart problems and death in patients with heart disease, according to U.S. health officials.

As a result, the federal Food and Drug Administration said Thursday that it’s recommending that doctors carefully weigh the benefits and risks of the drug before prescribing it to patients with heart problems.

The agency said its warning is based on a 10-year follow-up study of patients with coronary heart disease. The study found an unexpected and unexplained increase in deaths among heart disease patients who took clarithromycin for two weeks and were followed for one year or longer.

There’s no clear explanation for how clarithromycin would increase heart disease patients’ risk of death, the FDA said in a news release.

One heart specialist said this type of alert is worth heeding, however.

“It is important for health professionals and pharmacists to identify potential interactions between medications and eliminate prescription errors to prevent this risk,” said Dr. Marcin Kowalski. He directs cardiac electrophysiology at Staten Island University Hospital in New York City.

The FDA said it has added a new warning about this increased risk for heart patients, and is advising doctors to consider prescribing other antibiotics to these patients. The agency added that it will continue to monitor safety reports in patients taking clarithromycin.

The antibiotic is used to treat many types of infections affecting the skin, ears, sinuses, lungs and other parts of the body.

Doctors should talk to their heart patients about the risks and benefits of clarithromycin and alternative treatments. If doctors prescribe clarithromycin to patients with heart disease, they should inform those patients about the signs and symptoms of cardiovascular problems, the FDA said.

And patients with heart disease should tell their doctor about their condition, especially when they are being prescribed an antibiotic to treat an infection.

Heart disease patients should not stop taking their heart disease medicine or antibiotic without first talking to their doctor, the FDA said.

Patients taking the antibiotic should seek immediate medical attention if they experience symptoms of a heart attack or stroke, such as chest pain, shortness of breath or trouble breathing, pain or weakness in one part or side of the body, or slurred speech, the agency said.

Dr. Satjit Bhusri is a cardiologist at Lenox Hill Hospital in New York City.

He said, “Although this study suggests an association between this specific antibiotic, there have not been any direct correlations to increased heart disease.

“I would also extend this to all antibiotics in general. A short course of antibiotic therapy for a bacterial infection should be initiated if indicated by the physician; and a history of antibiotic therapy, at this time, should not be considered a risk factor for heart disease,” he said.

Source: HealthDay

‘Good’ Cholesterol Alone May Not Cut Heart Disease Risk

The long-standing advice about “good” vs. “bad” cholesterol has become a little more complicated.

According to some recent studies, we’re learning that good cholesterol alone has little ability to lower the risk of heart disease, and more is not necessarily better.

Instead, avoiding “bad” cholesterol while favoring “good” is only effective when combined with an overall healthy lifestyle that includes exercise and not smoking.

As most people know by now, bad cholesterol (low-density lipo­protein, or LDL) deposits excess cholesterol in your arteries, where it can build up into plaque, increasing the likelihood of heart disease and blood clots. Good cholesterol (high-density lipo­protein, or HDL) carries surplus cholesterol back to your liver so that it can be excreted.

To prevent heart disease, we’ve been told to keep our bad cholesterol level down and our good cholesterol level up—with 45 milligrams per deciliter usually offered as a good target.

Sounds pretty straightforward, right? But the picture is more complicated than it once seemed.

Here’s what you need to know about the current thinking, along with some healthy-heart guidelines that are unlikely to change even if our understanding of cholesterol does.

The New Evidence on HDL

The first clue that the role of good cholesterol was more complicated than previously thought emerged when scientists tried to develop medications to raise HDL levels.

The drugs they tested—niacin and cholesteryl ester transfer protein inhibitors—boosted HDL in the blood but failed to reduce cardiovascular-disease risk.

Those results surprised doctors. We know that certain lifestyle changes, such as exercising more and quitting smoking, drive HDL levels up and heart-disease risk down.

But increasing HDL levels arti­fi­cially, without behavioral changes, doesn’t reduce risk at all. “It turns out that HDL is not a very good therapeutic target,” says Dennis Ko, M.D., a cardiologist and senior scientist at the Institute for Clinical Evaluative Sciences in Ontario, Canada.

What’s more, Ko’s own research suggests that above a certain threshold, more HDL could increase health risks.

His team looked at 631,762 people and found that those with an HDL level greater than 70 mg/dL (in men) or 90 mg/dL (in women) were more likely to die—for reasons ­unrelated to cardiovascular disease.

Getting Good Cholesterol Up

As researchers work to figure out what these findings mean in the quest to keep hearts healthy, your doctors might still use your HDL level (in conjunction with measurements of LDL and total cholesterol) to help predict your cardiovascular-disease risk.

Our experts say that a very low HDL level can be a sign of trouble, but that the only meaningful way to raise it is through lifestyle changes.

“There is no evidence for a benefit from any HDL-raising drug,” says Steven Nissen, M.D., a cardiologist with the Cleveland Clinic. “It’s still important to pay attention to the numbers, but the main focus should be on making healthy choices.”

In other words, whether your HDL is low, high, or somewhere in the middle, the prescription for a healthy heart will be the same: Don’t smoke, drink alcohol only in moderation, exercise regularly, and stay away from trans fats, which are found in fried foods, baked goods, and other items made with partially hydrogenated oils.

As Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser, notes, “Everyone agrees with the pursuit of a healthy lifestyle.”

Bringing Bad Cholesterol Down

In 2016, the U.S. Preventive Services Task Force recommended that a vastly larger group think about taking statin medications, which lower LDL cholesterol.

If you’re 40 to 75 and have diabetes, or high cholesterol or blood pressure, or you smoke, you’re now advised to have a doctor estimate your chance of a major cardiovascular event within 10 years. If chances are 10 percent or greater, the task force suggests a statin. For a risk of 7.5 to 10 percent, it suggests that you consider one.

Our current advice is that for those whose 10-year risk is lower than 10 percent, diet and lifestyle changes should be the first steps. They could lower your risk enough that you are no longer a candidate for a statin, which has well-­established adverse effects.

Source: Consumer Reports