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- What is aspirin?
- What is aspirin therapy?
- What are the side effects of aspirin?
- What are the latest recommendations on the use of aspirin in the primary prevention of heart (cardiovascular) disease?
- What dosage of aspirin should I take to prevent and treat heart attacks and strokes?
- How effective is aspirin for preventing heart attacks among healthy people?
- Who should take aspirin to prevent and treat heart attacks and strokes?
- Who should not take aspirin to prevent heart attacks and strokes?
- When is aspirin used for preventing and treating heart attacks and strokes?
- Aspirin for treatment of heart attacks
- Aspirin for treatment of exertional and unstable angina
- Aspirin for treatment of ischemic strokes
- What is aspirin allergy?
- What drugs might interact with aspirin?
- What can be done to reduce the risk of ulcers from long-term aspirin use?
- What are the limitations of aspirin treatment?
- What is aspirin resistance?
- What is in the future for the research on aspirin resistance?
What is aspirin?
Aspirin belongs to a class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin and other NSAIDs like ibuprofen (Motrin, Advil, etc.) and naproxen (Aleve, etc.), are widely used to treat fever, pain, and inflammatory conditions such as arthritis, tendonitis, and bursitis. Aspirin has also been widely recommended for prevention of complications from athroscleotic disorders (heart attack, stroke and peripheral vascular disease). Aspirin is known chemically as acetyl salicylic acid and often abbreviated as ASA.
What is aspirin therapy?
Aspirin also has an important inhibitory effect on platelets in the blood. This antiplatelet effect is used to prevent clotting of blood inside arteries, particularly in individuals who have atherosclerosis (narrowing of the arteries) or are otherwise prone to develop blood clots in their arteries.
What are the side effects of aspirin?
Serious side effects of aspirin and other NSAIDs occur infrequently and generally tend to be more frequent with higher doses. It is advisable to use the lowest effective dose to minimize side effects.
The most common side effects of aspirin involve the gastrointestinal system, and include
- Ulcers of the stomach and duodenum (first part of the small intestine)
- Abdominal pain
- Gastritis (inflammation of the stomach)
- Even serious gastrointestinal bleeding from ulcers
Other side effects of aspirin include:
Sometimes, ulcers of the stomach and bleeding occur without any abdominal pain, and the only signs of bleeding may be:
Another serious but rare side effect of aspirin is intracranial hemorrhage (bleeding into the tissues of the brain), similar to a hemorrhagic stroke.
Occasionally, aspirin may be toxic to the liver.
Serious side effects of aspirin, such as bleeding ulcers or intracranial bleeding, are rare (less than 1% of patients) among patients taking moderate doses of aspirin (for example, 325 mg/day). Serious side effects of aspirin should be even lower with low doses such as 75-160 mg/day. However, the actual incidence of serious bleeding with long-term use of low dose aspirin has not been clearly determined.
These serious side effects also have been associated with aspirin:
- Thrombocytopenia (reduced blood platelets)
- Aplastic anemia (reduced production of red blood cells)
- Hemolytic anemia (increased destruction of red blood cells)
- Neutropenia (reduction of white blood cells)
- Pancytopenia (reduction of all cells in the blood
- Agranulocytosis (reduction of one type of white blood cell)
- Serious allergic reactions
Some individuals are allergic to NSAIDs and may develop shortness of breath when an NSAID is taken. People with asthma are at a higher risk for experiencing serious allergic reaction to NSAIDs. Individuals with a serious allergy to one NSAID are likely to experience a similar reaction to a different NSAID.
What are the latest recommendations on the use of aspirin in the primary prevention of heart (cardiovascular) disease?
In 2017, the U.S. Preventive Services Task Force (USPSTF) issued their final recommendations for the primary prevention of cardiovascular disease using aspirin. Based on their review of the published data:
- They encourage the use of low-dose aspirin in adults aged 50 to 59 years with a high risk of cardiovascular disease, who are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years.
- Adults who are 60 to 69 and have high risk of cardiovascular disease may receive daily aspirin based on individual circumstances. According to the recommendations, persons who are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years are more likely to benefit. Persons who place a higher value on the potential benefits than the potential harms may choose to initiate low-dose aspirin.
- In individuals younger than 50 years of age and older than 70 years of age, the data is insufficient to recommend daily aspirin.
In 2014 the FDA reviewed all the evidence on the use of aspirin for primary prevention and did not find sufficient evidence for use of aspirin for primary prevention.
What dosage of aspirin should I take to prevent and treat heart attacks and strokes?
An ideal dose of aspirin is one that maximizes its benefits but minimizes side effects. 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.
- At lower doses, such as 75 mg/day, the antiplatelet effect of aspirin can be achieved in several days instead of minutes. Since the risk of serious bleeding from aspirin is lower at lower doses, 75 mg/day is an appropriate dose for long-term primary and secondary prevention. Even though aspirin at doses as low as 40 mg/d has been shown to have anti-platelet effects, there is insufficient and inconclusive data to show that such low doses are effective in preventing heart attacks and ischemic strokes.
There also is no evidence that higher doses of aspirin, such as 1000 mg/day or higher, is more effective than lower doses. Some studies even suggest that higher doses may not be as effective as lower doses. Since the side effects of aspirin are more frequent with higher doses, doctors generally do not recommend higher doses for long-term use.
How effective is aspirin for preventing heart attacks among healthy people?
Long-term, low dose aspirin (75-160 mg/day) infrequently causes serious side effects. Among people with advanced atherosclerosis (people who already have heart attacks and strokes, patients with angina or TIAs, and patients who need PTCA and coronary artery bypass surgery). The benefits of low dose aspirin usually outweigh the risks of long-term aspirin (discussed in this article).
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.
The potential benefits of long-term aspirin in healthy subjects may not justify the 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.
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Who should take aspirin to prevent and treat heart attacks and strokes?
Even though aspirin is available without a doctor's prescription and has been used safely for many years by patients for fever and pain, patients should NOT take aspirin on a long-term basis without consulting with their doctor.
Aspirin prevents blood clots from forming inside arteries affected by atherosclerosis, but aspirin does not prevent atherosclerosis. Other measures (such as losing excess weight, controlling high blood pressure and diabetes, lowering LDL cholesterol, increasing HDL cholesterol, and stopping cigarette smoking) are necessary to prevent atherosclerosis.
Most doctors now recommend low doses of aspirin long-term for patients with advanced atherosclerosis for secondary prevention purposes. Such patients include those with:
- Prior heart attacks
- Prior strokes
- Exertional and unstable angina
- TIAs (transient ischemic attack, mini-stroke)
- Vascular procedures such as percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass surgery (CABG).
People who have not had a heart attack or stroke but have a high risk for developing a heart attack or stroke should also receive long-term low dose aspirin. For example, the American Diabetes Association recommends that people 50 years of age or older with type 1 or type 2 diabetes who have a high risk for heart attacks or strokes because of hypertension, smoking, a family history of stroke or heart attacks, or abnormal lipid levels should receive aspirin daily. Adults age 50 to 59 with a high risk of cardiovascular disease may also be considered for low dose aspirin treatment.
Who should not take aspirin to prevent heart attacks and strokes?
People who should not take aspirin include:
- People with an allergy to aspirin or other NSAIDs.
- People with active ulcers, especially those with bleeding ulcers, because of the side effects of ulcers and bleeding with aspirin. Among people who must take aspirin but have had intestinal ulcers, the lowest doses of aspirin should be used only after the ulcers heal. It should also be taken together with a proton pump inhibitor such as pantoprazole (Protonix), esomeprazole (Nexium), rabeprazole (Aciphex), or lansoprazole (Prevacid, Prevacid SoluTab) to decrease the risk of recurrent ulcers.
- Pregnant women and nursing mothers (since aspirin is secreted into breast milk).
- Teenagers and children with the flu or chickenpox because of the associated risk of Reye's syndrome, a serious disease of the liver and nervous system that can lead to coma and death.
- People with advanced kidney or liver diseases since aspirin may cause toxicity to the kidney and liver.
- People at risk for developing intracranial hemorrhage.
- Some people undergoing elective surgery or procedures. (Patients taking aspirin should discuss with their doctors whether to stop aspirin for several days to up to two weeks before surgery and procedures to avoid excess bleeding.)
According to the FDA there is no good evidence supporting the use of aspirin to prevent a heart attack or stroke in people who have a low risk of developing a heart attack or stroke.
When is aspirin used for preventing and treating heart attacks and strokes?
Aspirin is widely used either alone or in combination with other antiplatelet agents to prevent blood clots from forming in arteries. Aspirin is used specifically in several situations including:
- Aspirin often is prescribed in moderate doses (160-325 mg/day) for people who are having heart attacks to limit the extent of damage to the heart's muscle (by preventing further blood clot formation in the blood vessels of the heart and reduction of blood flow), prevent additional heart attacks, and improve survival.
- Aspirin often is prescribed to patients undergoing surgery to open or bypass blocked arteries, including percutaneous transluminal coronary angioplasty (PTCA) with or without placement of coronary stents and coronary artery bypass surgery (CABG). Aspirin also is prescribed on a long-term basis to prevent clotting in the stents and/or the bypassed blood vessels.
- Aspirin often is prescribed in low doses (75-160 mg/day) on a long-term basis to patients with prior heart attacks or strokes and to patients with TIAs (transient ischemic attacks or mini-strokes) and exertional angina to prevent heart attacks and ischemic strokes.
- Aspirin is prescribed in moderate doses (160-325 mg/day) to patients who are having unstable angina to prevent heart attacks and improve survival.
- Aspirin is prescribed in moderate doses (160-325 mg/day) to selected patients who are having ischemic strokes to limit damage to the brain, prevent a second stroke, and improve survival.
Aspirin for treatment of heart attacks
In a large multi-center study (Second International Study of Infarct Survival of the ISIS-2 trial) of patients having acute heart attacks, early treatment (within 24 hours of the onset of symptoms) with aspirin (160 mg/d) was found to reduce deaths from the heart attacks by 23%. The improved survival is believed to be due to aspirin's ability to quickly prevent further blood clots and the extension of existing clots and thus limit the amount of damage to the heart's muscle.
Aspirin is easy to use, safe at the low doses used for its antiplatelet action, and fast acting. Aspirin at moderate doses (160-325 mg/day) produces an antiplatelet effect rapidly (within 30 minutes). The current recommendation is to give aspirin immediately to almost all patients as soon as a heart attack is recognized at a dose of 160-325 mg/d and to continue it for one month. The only reason for not using aspirin is a history of intolerance or allergy to aspirin or evidence of obvious active bleeding (such as actively bleeding stomach ulcers) that might be worsened by aspirin.
Performance of vascular procedures
Aspirin is not the only treatment for heart attacks and unstable angina. Sometimes percutaneous transluminal coronary artery angioplasty (PTCA), with or without placement of an arterial stent, is necessary to open narrowed or blocked coronary arteries. In rare instances, PTCA may be technically impossible, or not practical, to do, and coronary artery bypass graft surgery (CABG) becomes necessary to improve the flow of blood to the heart.
Some patients with heart attacks also may be treated with thrombolytic agents (medications that dissolve clots) to open blocked arteries. It is important to make the distinction that aspirin generally does not dissolve an existing blood clot, but it acts to prevent growth of the existing clot and the formation of new ones. In all of these instances, there is a risk blood clots will form again inside the arteries, leading to further heart attacks. In all of these cases, aspirin has been shown to be beneficial in preventing new clots, thus reducing the risk of heart attacks and improving both short and long-term survival.
Prevention of further heart attacks
There are two types of heart attack prevention, primary and secondary. Preventing the first heart attack in people who do not have a history of heart disease is called primary prevention. Preventing further heart attacks among patients who already have had a heart attack or another heart related condition is called secondary prevention.
Within six years after the first heart attack, 16% of men and 35% of women will have a second heart attack. Long-term, daily aspirin (75-325 mg/d) has been shown to reduce the risk of second heart attacks and improve survival among both men and women. Additionally, long-term secondary prevention with aspirin also has resulted in fewer ischemic (lack of blood flow due to blockage in blood vessels from clot formation) strokes. Survivors of heart attacks usually take daily low dose (75 mg-160 mg/d) aspirin indefinitely to prevent further heart attacks as well as strokes.
Aspirin taken long-term is an important part but NOT the only measure for preventing heart attacks. Aspirin is not recommended for primary prevention of heart attacks because available evidence does not support its use for primary prevention.
Aspirin for treatment of exertional and unstable angina
Aspirin is particularly useful in preventing heart attacks and heart attack related deaths in patients with unstable angina. The Canadian Multicenter Trial, and the Montreal Heart Institute study all demonstrated significant reductions (approximately 50%) in the risk of heart attack among patients with unstable angina treated with aspirin. A study by the Research on Instability in Coronary Artery Disease Group (RISC) showed a 70% reduction in the risk of death or heart attack in patients with unstable angina treated with aspirin. Aspirin usually is started as soon as the diagnosis of unstable angina is made and then continued indefinitely.
In patients with prolonged chest pain due to unstable angina (a situation in which heart attacks are frequent), percutaneous transluminal coronary artery angioplasty (PTCA) with or without stenting may be necessary to open blocked coronary arteries. Aspirin is often used in combination with another antiplatelet agent, such as eptifibatide (Integrilin), and an anti-coagulant (heparin or low molecular weight heparin) to prevent heart attacks while awaiting the PTCA procedure. Aspirin then is used long-term (either alone or in combination with another antiplatelet agent) to prevent blood clots from forming inside the coronary arteries and stents.
In patients with exertional angina (chest pain brought on by exertion), low dose aspirin (75 mg-325 mg daily) given long-term has been shown to significantly reduce the risk of heart attacks, sudden death, and ischemic strokes.
Aspirin for treatment of ischemic strokes
Ischemic stroke is a process similar to a heart attack. In general, ischemia means injury to a tissue in the body due to lack of blood flow, and an ischemic stroke is injury to the brain tissue due to lack of blood perfusion. This usually happens because of atherosclerosis (narrowing and hardening of the blood vessels) of the arteries in the brain. Heart attack is the ischemia of the heart caused by similar process. Another major process for ischemic stroke may be due to an embolism (a blood clot that dislodges and travels from some other location in the body) to the blood vessels in the brain stopping blood from passing through the blood vessel.
When aspirin at moderate doses (160-350 mg/day) is given to patients as soon as an ischemic stroke is recognized (usually within the first 48 hours of the onset of symptoms), survival is improved, and the risk of additional strokes is reduced. Aspirin is believed to benefit patients having acute ischemic strokes by preventing the propagation (extension or growth) of the blood clots and preventing the complete obstruction of the arteries. However, aspirin is not effective in treating or preventing hemorrhagic strokes. Some studies suggest that long-term aspirin use may increase slightly the risk of developing hemorrhagic strokes.
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 this type of stroke, such as in patients with atrial fibrillation. In these patients, warfarin (Coumadin, Jantoven), 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.
What is aspirin allergy?
Allergy to aspirin is a rare condition in which a patient can develop swelling of tissues, spasm of the airways (bronchospasm) that causes difficulty breathing, and even anaphylaxis, a life-threatening condition. Patients with a history of allergy to aspirin should not take aspirin. Since aspirin is related chemically to the other NSAIDs, patients who are allergic to the other NSAIDs, such as ibuprofen (Motrin) and naproxen (Aleve), also should not take aspirin.
What drugs might interact with aspirin?
Aspirin may interact with other medications and cause undesirable side effects. For example:
- Aspirin, when taken together with an anti-coagulant such as warfarin (Coumadin) or enoxaparin (Lovenox), can greatly impair the body's ability to form blood clots, resulting in excessive bleeding spontaneously, from ulcers, or related to a procedure. Patients on such combinations must be closely monitored by a doctor.
- Aspirin can raise levels of uric acid in the blood and may need to be avoided in patients with increased uric acid levels or gout.
- Aspirin can increase the effect of medications used for lowering blood sugar levels in patients with diabetes, resulting in abnormally low blood sugar levels (hypoglycemia). Blood sugar levels may need to be more closely monitored.
- Certain NSAIDs, particularly ibuprofen (Motrin, Advil), if taken just before aspirin or in multiples doses each day, can reduce the anti-platelet effects of aspirin and theoretically render aspirin less effective in preventing heart attacks and ischemic strokes. The ibuprofen molecule is believed to adhere to the COX-1 enzyme, thus keeping aspirin from reaching the enzyme.
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What can be done to reduce the risk of ulcers from long-term aspirin use?
Long-term low dose aspirin use is generally safe. An estimated 10% of the patients taking long-term aspirin (75-325 mg/day) can develop ulcers. Most of these ulcers were asymptomatic (no abdominal pain or bleeding). Patients at a higher risk of developing ulcers with low dose aspirin included elderly patients age 70 years and older, and patients with H. pylori stomach infection (see below). The risk of significant ulcer bleeding from aspirin is low (approximately 1%). One can reduce the risk of bleeding by adding a daily dose of a proton pump inhibitor (PPI) that reduces stomach acid, for example, pantoprazole (Protonix), esomeprazole (Nexium), rabeprazole (Aciphex), or lansoprazole (Prevacid, Prevacid SoluTab), and omeprazole (Prilosec, Zegerid).
Misoprostil (Cytotec) is another type of drug that prevents ulcer formation by NSAIDs. It is a prostaglandin and probably prevents the detrimental effects of NSAIDs by replacing the prostaglandins that are not produced because of the inhibition of their formation by NSAIDs.
Chronic H. pylori infection of the stomach is found in up to 30% of adults in the U.S. Patients with gastritis due to H. pylori will have a higher risk of bleeding when given aspirin or NSAIDs long-term. Eradication of H. pylori from the stomach with antibiotics can reduce the risk of bleeding from chronic aspirin use.
Buffered and coated aspirin do not seem to prevent ulcers and ulcer bleeding.
What are the limitations of aspirin treatment?
Aspirin is not always effective in preventing strokes and heart attacks. Examples of possible causes of aspirin failure include:
- Poor patient compliance (not taking the medication regularly)
- Inadequate dosing
- Concurrent intake of other NSAIDs such as ibuprofen that interfere with the anti-platelet action of aspirin
- Activation of platelet aggregation via pathways not blocked by aspirin
- Aspirin resistance
What is aspirin resistance?
Aspirin resistance can be defined as the lack of antiplatelet effect despite therapeutic doses of aspirin (75mg-150mg/day for at least five days). This lack of anti-platelet response to aspirin increases the risk of developing heart attacks, strokes, and related deaths. Aspirin resistance is different from other causes of aspirin failure (see above), such as patient non-compliance or drug interference from concomitant use of ibuprofen.
Some scientists believe a segment of the population is resistant to the antiplatelet effect of aspirin. In these aspirin-resistant individuals, aspirin does not inhibit the formation of thromboxane A-2. Resistant individuals can be identified in research settings by finding high levels of 11-dehydrothromboxane B2 (a metabolic breakdown product of thromboxane A-2) in the urine while taking aspirin. These individuals have a higher risk of heart attack and strokes than subjects with lower urine levels of 11-dehydrothromboxane B2.
Another way of identifying aspirin resistance in research settings is by optical platelet aggregation. Aspirin non-responders identified by this method were found to have higher rates of heart attacks, strokes, and death than aspirin responders.
What is in the future for the research on aspirin resistance?
While research scientists are increasingly convinced that aspirin resistance exists, there are no reliable and standardized tests that doctors in clinical practice can use to diagnose this condition. Large scale controlled studies are needed to validate and standardize laboratory tests of aspirin resistance, and link these tests results to clinical outcomes.
Clinical trials will also be needed to determine how best to treat aspirin resistance. For example, should patients diagnosed as having aspirin resistance be treated with higher doses of aspirin? Should they be treated with aspirin in combination with another anti-platelet agent? Or should they be treated with a different anti-platelet agent, such as clopidogrel bisulfate (Plavix)?
Aspirin belongs to a drug class called NSAIDs (nonsteroidal anti-inflammatory drugs), and has an important inhibitory effect on platelets in the blood. Platelets are needed in order for blood clots to form. Because aspirin inhibits blood clotting, it is used to reduce the risk of recurrent stroke and near-stroke (transient ischemic attack). Aspirin therapy is used to prevent heart attacks and treat heart attacks.
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Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited. Treatment incorporates medications, physical therapy, and exercise.
Peripheral Vascular Disease
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 leg pain while walking, leg pain at rest, numbness in the legs or feet, and poor wound healing in the legs or feet. Treatment for peripheral artery disease include lifestyle measures, medication, angioplasty, and surgery.
Angina is chest pain due to inadequate blood supply to the heart. Angina symptoms may include chest tightness, burning, squeezing, and aching. Coronary artery disease is the main cause of angina but there are other causes. Angina is diagnosed by taking the patient's medical history and performing tests such as an electrocardiogram (EKG), blood test, stress test, echocardiogram, cardiac CT scan, and heart catheterization. Treatment of angina usually includes lifestyle modification, medication, and sometimes, surgery. The risk of angina can be reduced by following a heart healthy lifestyle.
Heart Attack (Myocardial Infarction)
A 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.
Transient Ischemic Attack (TIA, Mini-Stroke)
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.
Intermittent claudication, or pain and cramping in the lower leg is caused by inadequate blood flow to the leg muscles. This lack of blood flow causes a decrease in oxygen delivered to the muscles of the legs. Claudication is generally felt when walking and decreases with rest. In severe cases, claudication may be felt at rest. Narrowing of arteries cause claudication. Treatment includes exercise, medication, and in some cases surgery.
Atrial Fibrillation (AFib) Treatment Drugs
Atrial fibrillation (AFib) is a heart rhythm disorder that causes irregular and often rapid heartbeat. The medications to treat AFib include beta-blockers, blood thinners, and heart rhythm drugs. Atrial fibrillation drugs can cause serious side effects like seizures, vision changes, shortness of breath, fainting, other abnormal heart rhythms, excessive bleeding while coughing or vomiting, blood in the stool, and bleeding into the brain.
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms and signs include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves anti-inflammatory medications and exercise.
Polymyalgia rheumatica (PMR) is a disorder of the muscles and joints that causes pain and stiffness in the arms, neck, shoulders, and buttocks. Treatment for polymyalgia rheumatica aims to reduce inflammation with aspirin, ibuprofen, and low doses of cortisone medications.
Eosinophilic esophagitis is an inflammation of the esophagus. Eosinophilic esophagitis has many causes including acid reflux, heartburn, viruses, medications that become stuck in the esophagus, allergy, asthma, hay fever, allergic rhinitis, and atopic dermatitis. Eosinophilic esophagitis symptoms include difficulty swallowing food, abdominal pain, chest pain, and heartburn.
Nonsteroidal Anti-inflammatory Drugs and Ulcers
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.
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 anti-inflammatory medications.
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 anti-inflammatory drugs may also be used during treatment.
Omega-3 Fatty Acids
Omega-3 fatty acids are essential fats that help decrease one's cholesterol and triglyceride levels as well as reduce the risk of coronary artery disease. Omega-3s are found in salmon, sardines, walnuts, and canola oil. These fats may help reduce the risk of ventricular fibrillation and sudden cardiac death.
Stress and Heart Disease
The connection between stress and heart disease is not clear. Stress itself may be a risk factor, or high levels of stress may make risk factors for heart disease worse. The warning signs of stress can be physical, mental, emotional, or behavioral. Reducing stressors in an individuals life not only can lead to a more productive life, but may also decrease the risk for heart disease and causes of heart disease.
Heart Attack vs. Stroke Symptoms, Differences, and Similarities
Heart attack usually is caused by a clot that stops blood flow supplying oxygen to an area of heart muscle, which results in heart muscle death. Stroke or "brain attack" is caused by a loss of blood supply to the brain (usually a blood clot) or by hemorrhagic stroke (bleeding within the brain), which results in brain tissue death. Both heart attack and stroke usually come on suddenly, produce similar symptoms, can be disabling, and can be fatal. The classic symptoms and warning signs of heart attack are different. Classic heart attack warning signs are chest pain or discomfort, shortness of breath, pain that radiates to the shoulders, back, arms, belly, jaw, or teeth, sweating, fainting, and nausea and vomiting. Moreover, woman having a heart attack may have additional symptoms like abdominal pain or discomfort, dizziness, clammy skin, and moderate to severe fatigue. The classic symptoms and warning signs that a person is having a stroke are confusion or loss of consciousness, sudden severe headache, speech problems, problems seeing out of one or both eyes, and numbness or weakness of only one side of the body. Moreover, a woman having a stroke may have additional warning symptom and signs like shortness of breath, disorientation, agitation, behavioral changes, weakness, nausea, vomiting, seizures, and hiccups. Recognition of stroke symptoms is vital for emergency treatment. The acronym "FAST" stands for recognition of Facial drooping, Arm weakness, Speech difficulty, and a Time for action. If you experience the symptoms heart attack or stroke (FAST) or see them develop in another person, then contact 911 immediately.
Carotid Artery Disease
The term carotid artery disease refers to the narrowing of the carotid arteries and can also be called carotid stenosis. Fatty substance buildup and cholesterol deposits, called plaque are the cause of the narrowing arteries. Carotid artery disease can be treated by following recommended lifestyle changes, taking prescription medications, and considering a procedure to improve blood flow, if your doctor believes it could help.
Heart Attacks in Women
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.
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.
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 Attack Treatment
A heart attack involves damage or death of part of the heart muscle due to a blood clot. The aim of heart attack treatment is to prevent or stop this damage to the heart muscle. Heart attack treatments included medications, procedures, and surgeries to protect the heart muscle against injury.
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 anti-inflammatory drugs (NSAIDs), and cortisone medications.
Heart Disease in Women
Heart disease in women has somewhat different symptoms, risk factors, and treatment compared to heart disease in men. Many women and health professionals are not aware of the risk factors for heart disease in women and may delay diagnosis and treatment. Lifestyle factors such as diet, exercise, tobacco use, overweight/obesity, stress, alcohol consumption, and depression influence heart disease risk in women. High blood pressure, high cholesterol, and diabetes also increase women's risk of heart disease. Electrocardiogram (EKG or ECG), stress-ECG, endothelial testing, ankle-brachial index (ABI), echocardiogram, nuclear imaging, electron beam CT, and lab tests to assess blood lipids and biomarkers of inflammation are used to diagnose heart disease. Early diagnosis and treatment of heart disease in women saves lives. Heart disease can be prevented and reversed with lifestyle changes.
Heart Attack Pathology: Photo Essay
A heart attack is a layperson's term for a sudden blockage of a coronary artery. This photo essay includes graphics, pictures, and illustrations of diseased heart tissue and the mechanisms that lead to coronary artery disease, and possible heart attack. A coronary artery occlusion may be fatal, but most patients survive it. Death can occur when the occlusion leads to an abnormal heartbeat (severe arrhythmia) or death of heart muscle (extensive myocardial infarction).
Eosinophilic Fasciitis (Shulman's Syndrome)
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.
Guinea Worm Disease
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 Attack Prevention
Heart disease and heart attacks can be prevented by leading a healthy lifestyle with diet, exercise, and stress management. Symptoms of heart attack in men and women include chest discomfort and pain in the shoulder, neck, jaw, stomach, or back. Women experience the same symptoms as men; however, they also may experience: Extreme fatigue Pain in the upper abdomen Dizziness Fainting Leading a healthy lifestyle with a heart healthy low-fat diet, and exercise can help prevent heart disease and heart attack.
Aneurysm vs Stroke: Which Is Worse?
What is the difference between an aneurysm and a stroke?
Can Drinking Water Help Prevent a Stroke?
Many studies have proven that proper hydration at the time of a stroke is linked to better stroke recovery. It is possible that dehydration causes blood to be thicker. Viscous blood causes the body to retain sodium and increases blood pressure. Drinking enough water regularly prevents dehydration. This may play a role in keeping the blood less viscous, which in turn prevents a stroke.
Vitamins & Exercise: Heart Attack Prevention Series
Vitamins and exercise can lower your risk for heart attack and heart disease. Folic acid, vitamins, and homocysteine levels are interconnected and affect your risk for heart disease or heart attack. For better heart health, avoid the following: fried foods, hard margarine, commercial baked goods, most packaged and processed snack foods, high fat dairy, and processed meats such as bacon, sausage, and deli meats. Antioxidants and exercise also play a key role in heart attack and heart disease prevention. Lower your risk factors for heart disease and heart attack by: lowering cholesterol, lowering blood pressure, diabetes prevention, and smoking cesssation. Here are a few things you can do to prevent heart attacks: Eat whole, natural, fresh foods, eat five to 10 servings of fruits and vegetables daily, eat more omega-3 fatty acids, drink water, tea, non-fat dairy and red wine, eat lean proteins, limit glycemic foods, and exercise daily.
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.
Reye's syndrome (RS or Reye syndrome) is a sudden, sometimes fatal, disease of the brain with degeneration of the liver. Reye syndrome is associated with giving children 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.
Treating the Flu in People with Health Risks
Certain portions of the population are at an increased risk of suffering serious complications from the flu. Some of these indviduals at risk include: those with asthma, COPD, heart disease, liver or kidney disease, HIV, AIDs, elderly, women who are pregnant, and children under the age of two. Contact your physician if you have the flu immediately so that you receive the proper care to prevent serious complications.
Smoking and Heart Disease
Smoking increases the risk of heart disease in women and men. Nicotine in cigarettes decrease oxygen to the heart, increases blood pressure, blood clots, and damages coronary arteries. Learn how to quit smoking today, to prolong your life.
Certain behavioral, lifestyle, and environmental factors contribute to cancer. Cancer prevention involves modifying these factors to decrease cancer risk. Tobacco use, alcohol consumption, physical inactivity, inadequate fruit and vegetable intake, and obesity increase the risk of certain cancers. Vaccines, genetic testing, and cancer screening also play a role in cancer prevention.
How Can You Prevent a Stroke From Happening?
Strokes occur due to the obstruction of blood flow to the brain. Some irreversible factors, such as age and family history, are likely to increase the risk of stroke. These factors cannot be modified. However, many such preventable or modifiable factors can help prevent strokes.
Heart Disease Treatment in Women
Heart disease treatment in women should take into account female-specific guidelines that were developed by the American Heart Association. Risk factors and symptoms of heart disease in women differ from those in men. Treatment may include lifestyle modification (diet, exercise, weight management, smoking cessation, stress reduction), medications, percutaneous intervention procedure (PCI), and coronary artery bypass grafting (CABG). Heart disease is reversible with treatment.
Heart Attack Prevention Overview
Heart attacks are the major causes of unexpected, sudden death among men and women. A heart attack also is a significant cause of heart failure. The process of developing atherosclerosis (hardening of the arteries) begins early in life. Heart attack prevention should begin in childhood because the atherosclerosis process can not be reversed. The risk of having a heart attack increases if you have diseases or conditions such as high blood pressure, diabetes, and other heart conditions. You can lowering your risk of having a heart attack by: Lifestyle changes, for example: Diet Exercise Quit smoking Control high blood pressure, diabetes, and other diseases that are risk factors) In some cases, medication is the most effective way of preventing a heart attack
Treatment & Diagnosis
- What Are The Four Heart Sounds?
- Coronary Artery Bypass Graft (CABG)
- Percutaneous Coronary Intervention (PCI)
- What Are Three Signs of Cardiac Tamponade?
- What Are the Antibiotic Prophylactic Regimens for Endocarditis?
- What Are the Common Complications of Pulmonary Artery Pressure Monitoring?
- How Long Does a Mitral Valvuloplasty Last?
- What Is Pericardiocentesis?
- Sugar FAQs
- Heart Disease FAQs
- Stroke FAQs
- Salt FAQs
- Questions To Ask Your Doctor - General
- Drugs: Buying Prescription Drugs Online Safely
- Drugs: The Most Common Medication Errors
- Heart Attack Risk and Medicated Stents
- Medication Disposal
- Dangers of Mixing Medications
- Ibuprofen May Block Aspirin's Heart Benefits
- Generic Drugs, Are They as Good as Brand-Names?
Medications & Supplements
- Nonsteroidal Antiinflammatory Drugs (NSAIDs)
- aspirin (acetylsalicylic acid, Bayer, Ecotrin, and others)
- Aspirin vs. Plavix (clopidogrel)
- Aspirin vs. Aleve (Naproxen)
- Aspirin vs. NSAIDs (Side Effect and Use Differences)
- Aspirin vs. Xarelto (rivaroxaban)
- clopidogrel bisulfate (Plavix)
- Coumadin vs. Plavix (Differences and Similarities)
- Aspirin vs. warfarin (Coumadin, Jantoven)
- OTC Pain Relievers and Fever Reducers
- abciximab - injection, Reopro
- ticlopidine, Ticlid (discontinued brand in the US)
- What Are the Uses of Neuroprotective Agents in Stroke?
- Brilinta (ticagrelor)
- ivabradine (Corlanor)
Prevention & Wellness
- For Stroke Survivors, Timely Rehab Has Been Jeopardized During Pandemic
- Spirituality Helps Stroke Survivors, Caregivers Bounce Back
- Heart, Diabetes Drug Risks With COVID-19?
- Medical Groups Say Heart Meds Don't Worsen COVID-19 Symptoms
- After Heart Attack, Following Doctor's Orders Greatly Boosts Survival
- Wearable 'Brain Stimulator' May Boost Stroke Recovery
- Low-Dose Aspirin Might Cut Cancer Risk, Especially for Overweight People
- Smartphone App Gets Heart Patients to Follow Their Rx
- Health Tip: Controllable Stroke Risk Factors
- Could Daily Low-Dose Aspirin Still Help Some People?
- For Men, Living Alone May Mean Poorer Control of Blood-Thinning Meds
- AHA News: Study Finds Racial Gap in Who Gets Critical Stroke Treatments
- Aspirin, Anti-Clotting Meds Safe After Bleeding Stroke: Study
- Heart Attack Rehab at Home Could Save Lives
- Window for Safe Use of Clot-Buster Widens for Stroke Patients
- Quick Test Helps Predict Hospital Readmission Risk After Heart Attack
- Heart Patients Pay the Price When Nearby Pharmacy Closes
- Pros, Cons to Multiple Meds for Nursing Home Residents
- Why Do Older Heart Attack Patients Get Worse Care?
- Health Tip: Daily Aspirin Therapy
- AHA News: After 4 Strokes, Rare Disease and Brain Surgery, Woman Helps Others
- Stopping Aspirin 3 Months After Stent Is Safe, Study Finds
- Docs Back Away From Low-Dose Aspirin for Heart Attack Prevention
- Daily Aspirin Might Ease COPD Flare-Ups
- Aspirin Can Help Prevent Colon Cancer, But Many at Risk Don't Take It
- Food or Heart Meds? Many Americans Must Make a Choice
- Will Healthy Seniors Benefit From Daily Aspirin?
- Common Heart, Diabetes Meds May Help Ease Mental Illness
- 1 in 4 People Over 25 Will Be Hit by Stroke
- Fish Oil Pill Cuts Heart Dangers for High-Risk Patients
- Easing Sleep Apnea May Be Key to Stroke Recovery
- Is Daily Low-Dose Aspirin Really Worth It for Seniors?
- Aspirin, Fish Oil May Not Prevent Heart Trouble in Those Already at Risk
- Daily Low-Dose Aspirin May Be Weapon Against Ovarian Cancer
- Heart Meds May Be Wrong for Millions of Americans
- Is Low-Dose Aspirin Right for You After Surgery?
- Stopping Aspirin Tied to Quick Rise in Heart Attack, Stroke Risk
- Got Unused Meds? Here's What to Do
- Daily Low-Dose Aspirin Linked to Reduced Risk of Certain Cancers
- Should You Be Taking Aspirin Daily?
- More Evidence Daily Aspirin May Fight Colon Cancer, Other Gastro Tumors
- People in Their 50s Benefit Most From Low-Dose Aspirin, Report Says
- Low-Dose Aspirin, Other Painkillers May Lower Colon Cancer Risk
- Aspirin Use Common Among Americans With Heart Trouble
- Daily Aspirin Taken by More Than Half of Older U.S. Adults
- Aspirin 'Resistance' May Make for Worse Strokes: Study
- More Than 1 in 10 Use Daily Aspirin Inappropriately
- Text Messages Remind People to Take Medications
- Study Casts Doubt on Low-Dose Aspirin for Women Under 65
- Long-Term Use of Aspirin Plus Blood Thinner Is Safe: Study
- Daily Aspirin Fails to Help Older Hearts in Japanese Study
- Doctors May Miss Out on Recommending Aspirin Therapy
- Daily Aspirin May Help Prevent Cancer, Study Shows
- Study: Daily Low-Dose Aspirin May Help Ward Off Pancreatic Cancer
- Daily Aspirin Regimen Not Safe for Everyone, FDA Warns
- Aspirin May Not Protect Heart After Non-Cardiac Surgeries: Study
- Certain Colon Cancer Patients Might Benefit From Aspirin, Study Says
- Take Aspirin at Bedtime to Better Protect Your Heart, Study Suggests
- Aspirin's Anti-Colon Cancer Effect May Depend on Genes
- Aspirin Equals Pricier Blood Thinner for Preventing Clots: Study
- Skipping Aspirin Before Artery Procedure May Boost Death Rates
- Study Links Long-Term Aspirin Use With Vision Loss
- Regular Aspirin Use May Boost Eye Problem Risk
- Aspirin May Reduce Risk of Liver Cancer, Death From Liver Disease
- Daily Aspirin May Bolster Aging Brain, Study Shows
- Colon Cancer: Aspirin May Improve Survival in Some
- Adding Plavix to Aspirin Doesn't Help Guard Against Second Stroke: Study
- Daily Aspirin May Help Fight Prostate Cancer, But Not Breast Cancer
- Daily Aspirin May Reduce Risk of Cancer Death
- Daily Low-Dose Aspirin Risks Seem to Outweigh Gains for Many: Study
- Can Aspirin, Other NSAIDs Lower Skin Cancer Risk?
- Aspirin May Prevent Recurrence of Deep Vein Blood Clots
- Aspirin as Effective as Warfarin for Heart Failure: Study
- Low-Dose Daily Aspirin Enough to Help Heart Attack Patients: Study
- Daily Aspirin May Help Prevent and Treat Cancer
- Aspirin as Good as Plavix for Poor Leg Circulation: Study
- Aspirin, Warfarin Fare Equally for Heart Failure Patients
- Experimental Drug Might Beat Aspirin in Preventing Repeat Strokes: Study
- Aspirin Therapy for Heart Disease, Stroke Prevention Not for Everyone
- Health Tip: Use Medications Safely
- Aspirin May Reduce Risk of Repeat Blood Clots
- Most Drug-Related Hospitalizations Due to Handful of Drugs
Health Solutions From Our Sponsors
Report Problems to the Food and Drug Administration
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American Diabetes Association. "Diabetes Care." January 2016 Volume 39, Supplement 1.
C. H. Hennekens, MD; M. L. Dyken, MD; V. Fuster, MD. "Aspirin as a Therapeutic Agent in Cardiovascular Disease." Circulation. 1997;96:2751-2753
Cairns JA, Gent M, Singer J, Finnie KJ, Froggatt GM, Holder DA, Jablonsky G, Kostuk WJ, Melendez LJ, Myers MG, et al.; "Aspirin, sulfinpyrazone, or both in unstable angina. Results of a Canadian multicenter trial." N Engl J Med. 1985 Nov 28;313(22):1369-75.
ISIS-2 (Second International Study of Infarct Survival) Collaborative Group (1988), "Randomized Trial of Intravenous Streptokinase, Oral Aspirin, Both, or Neither Among 17 187 Cases of Suspected Acute Myocardial Infarction: ISIS-2", The Lancet 332: 349-360
LC Wallentin. "Aspirin (75 mg/day) after an episode of unstable coronary artery disease: long-term effects on the risk for myocardial infarction, occurrence of severe angina and the need for revascularization. Research Group on Instability in Coronary Artery Disease in Southeast Sweden." J Am Coll Cardiol, 1991; 18:1587-1593
Theroux P; Ouimet H; McCans J; Latour JG; Joly P; Levy G; Pelletier E; Juneau M; Stasiak J; deGuise P; et al. "Aspirin, heparin, or both to treat acute unstable angina." Journal of Medicine Vol. 319:1105-1111
U.S. Preventive Services Task Force. "Final Recommendation Statement: Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: Preventive Medication." Updated: Apr 12, 2016.