My monthly column at Endurance Corner is devoted to the issue of ideal heart health. This topic has been in the news lately and I thought I’d offer some thoughts about the American Heart Association (AHA) “Simple 7.” Check it out.
An Aspirin a Day?
Today, we’ll talk about aspirin….and whether you might benefit from taking a daily aspirin tablet.
First, a little about aspirin itself. It’s complete name is acetylsalicylic acid, or ASA for short. It comes in a variety of sizes, but the most common are 81 mg (the “baby” aspirin) and 325 mg (the standard dose). Aspirin is used for a variety of purposes, including as an analgesic (pain reliever), an anti-pyretic (relieves fever), and as an anti-inflammatory medication. The main unwanted side effect of aspirin is a small risk of stomach bleeding.
Today, we’ll focus on the use of aspirin to prevent adverse events such as heart attack, stroke, or vascular disease.
Individuals who already have cardiovascular disease (CVD)
For people who already have cardiovascular disease (of almost any sort), aspirin has been shown in many studies (involving 10’s of thousands of patients) to reduce the chance of having heart attack, stroke, or new vascular disease. We call this “secondary prevention”–preventing a “second” problem. If you fit into this category, you should talk with your doctor about taking aspirin or other similar medication.
Individuals who DO NOT have cardiovascular disease (CVD)
For this group of people, recommendations about aspirin use are a little more complicated. We call this “primary prevention”–preventing the first episode of important CVD.
If we look at this entire group of healthy people, aspirin HAS NOT been shown convincingly to reduce the chances of developing important CVD, but…. It turns out that for SOME healthy people–those with a somewhat elevated risk (based on risk factors) of developing CVD at some point–aspirin actually does provide a benefit. So….the issue becomes sorting out which people benefit and which people do not.
This is where my previous Blog Post comes into play. You should use the worksheets and tables (separate worksheets and tables for men and women) to determine your 10-year risk of developing CVD. Many of you will find that that risk is nearly zero, but you’ll also see that the presence of any risk factor can elevate that risk substantially.
The American Heart Association recommends daily aspirin for patients whose 10-year risk of CVD is >=10%. That’s pretty easy. But there may be good reason to use daily aspirin even if your risk is less than that. A useful algorithm for making decisions about daily aspirin for primary prevention was published in the 2007 Guide to Clinical Preventive Services by the Agency for Healthcare Research and Quality (AHRQ):
“Men older than 40 years, postmenopausal women, and younger people with risk factors (eg, hypertension, diabetes, or smoking) are at increased risk for heart disease and may wish to consider aspirin therapy.”
I believe this is a useful approach. If you are healthy and have ANY risk factor for CVD, you should discuss the potential benefits of daily aspirin therapy with your doctor.
How much aspirin?
It turns out that a daily baby aspirin (81 mg) is probably just as effective as the standard dose (325 mg)….and may reduce the chances of having stomach bleeding.
So, to summarize…. Daily aspirin use is effective for secondary prevention. It is also effective for primary prevention in some patients, particularly those with risk factors for CVD. It is wise to discuss the benefits and risks of aspirin with your doctor before starting this medication, though, because there is a very real risk of unwanted stomach (or other) bleeding. And lastly, a baby aspirin is probably the right dose for most people.
What is YOUR Risk?
I’ve gotten a couple questions recently from athlete friends about using aspirin to help prevent heart disease. Just before I started the Athletes Heart Blog, I had some discussion with my triathlon friends about this issue, and I thought I’d share my thoughts with a broader audience here.
Later this week, in a separate blog post, I’ll talk about aspirin specifically.
But first….we need to talk about your risk of developing coronary heart disease (CHD). And by this, I mean the collection of clinical problems caused by coronary artery disease (CAD)—sudden death, heart attack, angina—that I discussed in a previous blog post. It’s important to know YOUR personal risk for the development of CHD because the effectiveness of drugs (or other treatments) in PREVENTING you from developing CHD depend very much on your inherent RISK.
Over many decades, data have been collected by the Framingham study on a very large number of Americans about their health and lifestyle habits. One byproduct from this large database has been the development of equations that can be used to predict your 10-year risk of developing CHD.
Use the “worksheets” below to tally up points for your LDL score and your Chol score. When you’ve tallied up the points, you’ll use the appropriate table to determine your 10-year risk of CHD. We need to consider men and women separately because the risks are different….and so there are separate “worksheets” and tables for men and women.
Now you’ll know YOUR risk. This is an important number and you should talk about this with your doctor when you visit.
Next time, we’ll talk about whether aspirin can reduce your risk of CHD. And we’ll be able to talk about other prevention strategies as well. Check back later this week.
FOR MEN
Step 1. Age
Years
30-34: LDL score = -1; Chol score = -1.
35-39: LDL score = 0; Chol score = 0.
40-44: LDL score = 1; Chol score = 1.
45-49: LDL score = 2; Chol score = 2.
50-54: LDL score = 3; Chol score = 3.
55-59: LDL score = 4; Chol score = 4.
60-64: LDL score = 5; Chol score = 5.
65-69: LDL score = 6; Chol score = 6.
70-74: LDL score = 7; Chol score = 7.
Step 2. Serum lipid levels
LDL cholesterol (mg/dL)
100-159: LDL score = 0.
160-190: LDL score = 1.
>=190: LDL score = 2.
Cholesterol (mg/dL)
160-199: Chol score = 0.
200-239: Chol score = 1.
240-279: Chol score = 2.
>=280: Chol score = 3.
HDL cholesterol (mg/dL)
35-44: LDL score = 1; Chol score = 1.
45-54: LDL score = 0; Chol score = 0.
>=55: LDL score = -1; Chol score = -2.
Step 3. Blood pressure (check your score for systolic and diastolic blood pressures, but use ONLY the highest score, not both)
Systolic pressure (top number, mmHg)
120-129: LDL score = 0; Chol score = 0.
130-139: LDL score = 1; Chol score = 1.
140-159: LDL score = 2; Chol score = 2.
>=160: LDL score = 3; Chol score = 3.
Diastolic pressure (bottom number, mmHg)
80-84: LDL score = 0; Chol score = 0.
85-89: LDL score = 1; Chol score = 1.
90-99: LDL score = 2; Chol score = 2.
>=100: LDL score = 3; Chol score = 3.
Step 4. Diabetes
No: LDL score = 0; Chol score = 0.
Yes: LDL score = 2; Chol score = 2.
Step 5. Smoker
No: LDL score = 0; Chol score = 0
Yes: LDL score = 2; Chol score = 2
FOR WOMEN
Step 1. Age
Years
30-34: LDL score = -9; Chol score = -9.
35-39: LDL score = -4; Chol score = -4.
40-44: LDL score = 0; Chol score = 0.
45-49: LDL score = 3; Chol score = 3.
50-54: LDL score = 6; Chol score = 6.
55-59: LDL score = 7; Chol score = 7.
60-64: LDL score = 8; Chol score = 8.
65-69: LDL score = 8; Chol score = 8.
70-74: LDL score = 8; Chol score = 8.
Step 2. Serum lipid levels
LDL cholesterol (mg/dL)
100-159: LDL score = 0.
160-190: LDL score = 2.
>=190: LDL score = 2.
Cholesterol (mg/dL)
160-199: Chol score = 0.
200-239: Chol score = 1.
240-279: Chol score = 1.
>=280: Chol score = 3.
HDL cholesterol (mg/dL)
35-44: LDL score = 2; Chol score = 2.
45-49: LDL score = 1; Chol score = 1.
45-54: LDL score = 0; Chol score = 0.
>=55: LDL score = -2; Chol score = -3.
Step 3. Blood pressure (check your score for systolic and diastolic blood pressures, but use ONLY the highest score, not both)
Systolic pressure (top number, mmHg)
120-129: LDL score = 0; Chol score = 0.
130-139: LDL score = 0; Chol score = 0.
140-159: LDL score = 2; Chol score = 2.
>=160: LDL score = 3; Chol score = 3.
Diastolic pressure (bottom number, mmHg)
80-84: LDL score = 0; Chol score = 0.
85-89: LDL score = 0; Chol score = 0.
90-99: LDL score = 2; Chol score = 2.
>=100: LDL score = 3; Chol score = 3.
Step 4. Diabetes
No: LDL score = 0; Chol score = 0.
Yes: LDL score = 4; Chol score = 4.
Step 5. Smoker
No: LDL score = 0; Chol score = 0.
Yes: LDL score = 2; Chol score = 2.
Useful Article: 8 Ways to Prevent Heart Disease
I ran across this article (actually I received a Tweet about it) last week from active.com. The article elaborates a little bit on the 6 risk factors for CAD that I mentioned previously that are within your control.
The article also mentions 2 additional ways to help reduce your risk of CAD:
1. Consider a drink a day and
2. Consider low-dose aspirin.
Both of these additional suggestions are good ones. In upcoming posts, we’ll talk in more detail about all of these risk factors and suggestions for reducing your risk of CAD.
In the News: Cardiac Screening for High School Athletes
At last week’s meeting of the American Heart Association, a group of investigators from Johns Hopkins University School of Medicine presented their findings about rigorous pre-participation cardiac screening in a small group of high school athletes. Their detailed findings probably won’t appear in a medical journal for a year or more, but this article at sciencedaily.com summarizes the results.
The screening process included a physical examination, an echocardiogram, and an EKG. Although the authors did not find any life-threatening abnormalities among the 134 athletes studied, they did find significant abnormalities in 36 of the athletes that required further evaluation.
The authors concluded that the addition of an echocardiogram and EKG was important in this population.