It is important to recognize that aspirin is not the
preferred treatment for ischemic strokes. Thrombolytic medications (medications
that dissolve clots) are used early (as soon as an ischemic stroke is
recognized) to open blocked cerebral arteries.
The major limitation for using these medications is time. For example, for an
ischemic stroke, thrombolytics must be given within the first three hours after
the first symptoms of a stroke. Many people with strokes may not recognize the
symptoms and may delay medical attention for several hours if not days after the
onset of stroke symptoms.
Another limitation in their use is that only certain patients qualify to
receive these medications. As a result, for patients in whom thrombolytic
medications cannot be used (most often because of underlying conditions that can
cause excessive bleeding), doctors may consider using aspirin. Thus, aspirin is
often the drug that patients with stroke will receive when they are seen in the
emergency room.
Prevention of strokes
Patients with prior strokes and TIAs (mini-strokes) usually have significant
atherosclerosis of the carotid and /or the smaller arteries within the brain and
are at risk of further strokes. (These patients often have coronary
atherosclerosis as well and are at risk for heart attacks.) Long-term
low-to-moderate doses of aspirin (50-325 mg/d) have been found to reduce the
risk of strokes as well as heart attacks in these patients.
Aspirin is not the only medication to prevent strokes among patients with
atherosclerosis. Another anti-platelet agent, clopidogrel (Plavix), also has
been used, especially in patients who are intolerant or allergic to aspirin.
Aspirin is sometimes combined with a second anti-platelet agent, dipyridamole
(Persantine, Aggrenox), to prevent strokes.
Antiplatelet agents are not the only measures that prevent
strokes. For example, aspirin alone may not be sufficient to prevent embolic
strokes in patients at risk for these strokes, such as in patients with
atrial
fibrillation. In these patients, warfarin (Coumadin), an oral anti-coagulant
that is a stronger anti-clotting medication than aspirin, may be necessary.
In patients with ischemic strokes or TIAs who have advanced atherosclerosis
and narrowing of the carotid arteries, carotid endarterectomy (a surgical
procedure to widen the narrowed carotid artery, the main blood vessel feeding
the brain) or the introduction of stents within the carotid artery may be
necessary to prevent strokes.
How effective is aspirin for preventing heart attacks among healthy subjects?
Long-term, low dose aspirin (75-160 mg/d) infrequently
causes serious side effects. Therefore, among patients with advanced
atherosclerosis (patients who already have heart attacks and strokes, patients
with angina or TIAs, patients who need PTCA and coronary artery bypass surgery,
and patients with symptoms of peripheral vascular disease) the benefits of low dose aspirin usually outweigh
the risks of long-term aspirin (discussed below).
Unlike the treatment of patients with advanced atherosclerosis, aspirin use
among healthy subjects (for example, individuals with no prior heart attacks or
strokes) is more controversial. In the U.S. Physicians' Health Study (a study
comparing 325 mg of aspirin every other day to placebo among more than
20,000 healthy male doctors), there were fewer heart attacks among aspirin users
as compared to placebo users. However, the overall rate of death from heart
disease
was no different between aspirin users and men on placebo. Furthermore, there is
insufficient data to evaluate the benefit of aspirin among healthy women.
Therefore, the potential benefits of long-term aspirin in
healthy subjects may not justify the small risks of serious side effects of
aspirin, including bleeding from ulcers and blood vessels in the brain. Healthy
individuals should discuss long-term therapy with aspirin with their doctors before they start
taking aspirin. Most doctors recommend aspirin in healthy subjects who have one
or more risk factors for developing atherosclerosis.
What are the latest recommendations on the use of aspirin
in the primary prevention of cardiovascular disease?
As described below, the recommendations for the secondary prevention (in
people who already have had a heart attack or stroke) of future attacks are more
compelling.
In 2009, the U.S. Preventive Services Task Force (USPSTF) has come up with
slightly modified recommendations for the primary prevention of cardiovascular
disease using aspirin. Based on their review of the published data:
They
encourage the use of aspirin in men between 45-79 years of age and women between
55-79.
In individuals older than 80, the treatment with aspirin was associated
with more bleeding episodes which outweigh the protective benefits.
In men
younger than 45 and women younger than 55, the benefits of aspirin seemed to too
insignificant to warrant routine use for the prevention of cardiovascular
disease.
What is the optimal dose of aspirin for treating and preventing heart attacks and strokes?
An ideal dose of aspirin is one that maximizes its benefits but minimizes
side effects. However, the ideal dose of aspirin for primary or secondary
prevention of ischemic strokes and heart attacks has not been established
firmly.
In situations where an immediate antiplatelet effect is needed (for example,
in the treatment of acute heart attacks, ischemic strokes, and unstable angina)
aspirin at moderate doses (160–325 mg/day) will produce rapid and immediate
antiplatelet effects. In the ISIS-2 trial, a dose of 160 mg/day given within 24
hours of the onset of symptoms of heart attack was shown to decrease deaths due
to heart attacks by 23%. Therefore, this is the dose recommended for acute heart
attacks and unstable angina.
The knee joint is composed of three compartments and ligaments which stabilize the joint. Causes of knee pain may include injury, degeneration, infrequently infection and rarely bone tumors. Although routine x-rays do not revel meniscus tears, they can be used to exclude other problems of the bones and tissues. The knee joint is the most commonly involved joint in rheumatic disease, as well as immune diseases that affect various tissues of the body.
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Angina is chest pain that is due to an inadequate supply of oxygen to the heart muscle.
Angina can be caused by coronary artery disease or spasm of the coronary
arteries. EKG, exercise treadmill, stress echocardiography, stress thallium, and cardiac
catheterization are important tests used in the diagnosis of angina.
Heart attack happens when a blood clot completely obstructs a coronary
artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical
instability of the heart.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited.
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves antiinflammatory medications and exercise.
Polycythemia (elevated red blood cell count) causes are either primary (aquired or genetic mutations) or secondary (diseases, conditions, high altitude). Treatment of polycythemia depends on the cause.
Heart disease (coronary artery disease) is caused by a buildup of cholesterol deposits in the coronary arteries. Risk factors for heart disease include smoking, high blood pressure, heredity, diabetes, peripheral artery disease, and obesity. Symptoms include chest pain and shortness of breath. There are a variety of tests used to diagnose coronary artery disease. Treatment includes life-style changes, medications, procedures, or surgery.
Peripheral vascular disease (PVD) refers to diseases of the blood vessels (arteries and veins) located outside the heart and brain. While there are many causes of peripheral vascular disease, doctors commonly use the term peripheral vascular disease to refer to peripheral artery disease (peripheral arterial disease, PAD), a condition that develops when the arteries that supply blood to the internal organs, arms, and legs become completely or partially blocked as a result of atherosclerosis. Peripheral artery disease symptoms include: intermittent claudication, rest pain, numbness in the extremities, and more. Treatment for peripheral artery disease include: lifestyle measures, medication, angioplasty, and surgery.
Sickle cell anemia (sickle cell disease), a blood disease which shortens life expectancy, is cause by an inherited abnormal hemoglobin. Symptoms may include bacterial infections, painful swelling of the hands and feet, fever, leg ulcers, fatigue, anemia, eye damage, and lung and heart injury. Treatment for sickle cell anemia aims to manage and prevent the worst manifestations of the disease and focuses on therapies that block red blood cells from stacking together, which can lead to tissue and organ damage and pain.
When a portion of the brain loses blood supply, through a blood clot or embolus, a transient ischemic attack (TIA, mini-stroke) may occur. If the symptoms do not resolve, a stroke most likely has occurred. Symptoms of TIA include: confusion, weakness, lethargy, and loss of function to one side of the body. Risk factors for TIA include vascular disease, smoking, high blood pressure, high cholesterol, and diabetes. Treatment depends upon the severity of the TIA, and whether it resolves.
Kawasaki disease is a rare children's disease characterized by a fever that lasts more than five days and at least four of the following five symptoms are present: rash, swollen neck lymph gland, red tongue, swelling or redness of the hands or feet, and conjunctivitis. High doses of aspirin are used to treat Kawasaki disease. Cortisone and antiinflammatory drugs may also be used during treatment.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Reactive arthritis is a chronic, systemic rheumatic disease characterized by three conditions, including conjunctivitis, joint inflammation, and genital, urinary or gastrointestinal system inflammation. Inflammation leads to pain, swelling, warmth, redness, and stiffness of the affected joints. Non-joint areas may experience irritation and pain. Treatment for reactive arthritis depends on which area of the body is affected. Joint inflammation is treated with antiinflammatory medications.
Vascular disease includes any condition that affects your circulatory system. Vascular disease ranges from diseases of your arteries, veins and lymph vessels to blood disorders that affect circulation.
Heart disease, particularly coronary artery disease is the leading cause of heart attacks. Women are more likely to die from a heart attack than men. High cholesterol, high blood pressure, obesity, and high triglycerides are contributors to heart disease. Some of the common symptoms of a heart attack in women include chest pain, shortness of breath, nausea, feeling faint or woozy, and more. Heart disease can be prevented by lifestyle changes and controlling high blood pressure, cholesterol, weight, and diseases such as diabetes.
Reye's syndrome (RS, or Reye syndrome) is a sudden, sometimes fatal, disease of the brain with degeneration of the liver. Reye syndrome occurs in children and comes after the chickenpox or an influenza-type illness, is also associated with taking medications containing aspirin. Symptoms include vomiting, listlessness, irritability or combativeness, confusion, delirium, delusions, convulsions, and loss of consciousness. Treatment depends on early diagnosis and focuses on protecting the brain against irreversible damage by reducing brain swelling, reversing the metabolic injury, preventing complications in the lungs, and anticipating cardiac arrest.
Nonsteroidal antiinflammatory drugs (NSAIDs) are prescribed medications for the treatment of inflammatory conditions. Examples of NSAIDs include aspirin, ibuprofen, naproxen, and more. One common side effect of NSAIDs is peptic ulcer (ulcers of the esophagus, stomach, or duodenum). Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking NSAIDs.
Heart attacks are the major causes of unexpected, sudden death among men and women. A heart attack is also a significant cause of heart failure. Learn the risk factors for heart attack such as high blood pressure, diabetes, and other heart conditions. Lowering your risk factor, lifestyle changes, and in some cases medication are the most effective way of preventing a heart attack.
SAPHO syndrome is a chronic disorder that involves the skin, bone, and joints. SAPHO syndrome is an eponym for the combination of synovitis, acne, pustulosis, hyperostosis, and osteitis. SAPHO syndrome is related to arthritic conditions such as ankylosing spondylitis and reactive arthritis. Treatment is directed toward the individual symptoms that are present, and includes medications such as nonsteroidal antiinflammatory drugs (NSAIDs), and cortisone medications.
Eosinophilic fasciitis is a skin disease that causes thickening and inflammation of the skin and fascia. Symptoms include redness, warmth, and hardening of the skin, as well as occasional tissue and joint pain. Treatment for eosinophilic fasciitis aims to eliminate inflammation through the use of aspirin, NSAIDs, and cortisone. Aggressive forms of eosinophilic fasciitis may require the use of immune suppression medications.
A heart attack is a layperson's term for a sudden blockage of a coronary artery. This photo essay inlcudes graphics, pictures, and illustrations of diseased heart tissue and the mechanisms that lead to coronary artery disease, and possible heart attack.
Stroke is the third leading killer in the United States. Some of the warning signs of stroke include sudden confusion, trouble seeing with one or both eyes, dizziness, loss of balance, and more. Stroke prevention and reatable risk factors for stroke include lowering high blood pressure, quit smoking, heart disease, diabetes control and prevention.
Guinea worm disease (GWD or dracunculiasis) is an infection caused by the parasite Dracunculus medinensis. After a person drinks water contaminated by water fleas that harbor Guinea worm larvae, the larvae grow into adult worms (2-3 feet) in the small intestine and then migrate and emerge from the skin. Symptoms and signs include fever, swelling, and pain near the blister on the skin where the worm will emerge. As there is no medication to treat GWD and no vaccine to prevent infection, treatment focuses on minimizing pain and swelling (with the use of ibuprofen or aspirin) as the worms are slowly pulled from the wound over the course of a few days to a few months.
Heart RSS
Healthy Living Tips
