Heart Medications Archive

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Daily aspirin for disease prevention: When do the benefits outweigh the risks?

A daily aspirin may help defend against heart disease, but it should still be used with caution.


Image: FlairImages/Thinkstock

Aspirin tablets have been a staple of home medicine cabinets and first-aid kits for nearly 100 years. Long before that, people chewed willow tree bark, which contains aspirin-like compounds, to treat a variety of ailments. On top of being an excellent painkiller and fever reducer at its standard dosage, aspirin dramatically reduces the risks for a second heart attack and certain types of stroke when taken daily at a low (81-mg) dose. Research also suggests that aspirin might help limit the growth of colorectal cancer and possibly inhibit other cancers as well, but more research in this area is needed.

These benefits, coupled with the fact that aspirin is both cheap and relatively safe, have led the U.S. Preventive Services Task Force (USPSTF) to recommend that even some healthy people take a daily aspirin to ward off future disease. But figuring out exactly who is likely to benefit most from this therapy is a more complex calculation, says Dr. Michael Gaziano, a professor of medicine at Harvard Medical School and cardiologist at Brigham and Women's Hospital.

Why you should always have aspirin on hand

This old standby may not be your first choice for pain relief, but it still has an important role in disease prevention and first aid.


Image: Thinkstock

We have a lot to thank aspirin for. It's cheap and plentiful. It does a good job of relieving pain and bringing down fevers. It has also been shown to reduce the risk of heart attack, stroke, and colon cancer. It can even stop heart attacks and strokes in their tracks. In fact, if you're in your 50s or 60s, you may want to think about taking a low-dose aspirin every day.

After evaluating the results of scores of studies, in April 2016 the U.S. Preventive Services Task Force (USPSTF) recommended that women and men ages 50 through 69 who have a 10% risk of a heart attack or stroke in the next 10 years take 81 milligrams (mg) of aspirin daily. Under the previous recommendations—which, were different for men and women—daily low-dose aspirin was advised for women ages 60 through 79 who were at increased risk for cardiovascular events. The recommendation was revised to reflect a new method of calculating the risk of heart attack and stroke and of increased risk of bleeding in older people.

Risk of serious falls linked to changes in blood pressure drugs

When older people start taking a new blood pressure drug or change the dose of their current drug, they may be more prone to a serious fall during the following two weeks. But this increased fall risk doesn’t seem to persist over the long term. 

Strategies for taking medications

Doctors may prescribe medications in hopes of helping a patient, but statistics show that at least half of all patients do not follow through with the treatment. Dr. Robert Schmerling explains why some people are choosing to skip taking medications and the possible results of not taking them.

Coping with statin side effects

Some people experience muscle aches or muscle cramps, but trying these tips may help.


About 10% to 20% of inidividuals who take statins report that they experience muscle pain or muscle cramps. 
Image: rogerashford/Thinkstock

Statins, such as atorvastatin (Lipitor), simvastatin (Zocor), rosuvastatin (Crestor), and lovastatin (Mevacor), are commonly prescribed medications that lower "bad" LDL cholesterol and have been shown to help reduce the risk of heart attack, stroke, and death.

Atrial fibrillation: The latest treatment trends

About one in six strokes can be traced to atrial fibrillation. Doctors now have newer and better options to lessen this risk.

Close to one in 10 people ages 65 or older have atrial fibrillation (afib), the most common heart rhythm disorder. During a bout of afib, the usually rhythmic contractions of the heart's upper chambers (the atria) are replaced by an ineffectual quiver. While the symptoms, which include a racing heartbeat, dizziness, and shortness of breath, are troublesome for some people, the real threat lies in the increased risk of stroke that accompanies the condition.

When the heart takes on the afib rhythm, blood does not completely move out of the atria. Instead, it tends to pool and clot in a pouchlike extension in the upper left quadrant of the heart, called the left atrial appendage. If these clots break loose, they may travel to the brain and cause a blockage. This is known as an ischemic stroke.

Muscle problems caused by statins: Can a genetic test reveal your risk?

A mail-order saliva test marketed to consumers may make some promises it can't deliver.

A new mail-order genetic test called StatinSmart bills itself as the first test to identify a person's risk of experiencing muscle pain from a statin. That sounds like potentially helpful information, given that up to half of people who are prescribed statins quit taking them because of perceived side effects—most often muscle pain. Others avoid statins altogether because of that worry.

But here's the rub: muscle problems can range from mild to serious, and the terms experts use to describe them can be confusing. The StatinSmart website says 29% of people who take a statin develop "statin-induced myopathy," which they define as muscle aches, pains, weakness, or cramps.

Why you may need a statin

Although risk calculators disagree, at some point age becomes the deciding factor in the decision to take a cholesterol-lowering medication.


Image: Thinkstock

If you've been diligent about monitoring your risk factors for developing heart disease, you may have realized that online calculators can be helpful. If you have the results from your latest cholesterol test, these online calculators can compute your chance of having a heart attack or stroke in the next decade:

However, each may give you a slightly different number. And while the Framingham calculator might indicate that your risk is low and therefore you don't need a cholesterol-lowering statin drug, the ACC/AHA calculator could indicate that you should be taking a statin to reduce your risk.

Ask the doctor: Medications that affect warfarin

Ask the doctor

Q. I'm helping my mother, who is in her late 80s, keep track of her medications, as she can be a little forgetful. Her doctor just started her on warfarin, which I've heard can interact with many different medications. What are the most common ones?

A. Warfarin (Coumadin), a widely prescribed clot-preventing drug, can be affected by many medications, but antibiotics and related drugs are the most common source of problems. One example is the antibiotic that contains sulfamethoxazole and trimethoprim (Bactrim), which is often used to treat urinary tract infections and bronchitis. It interferes directly with warfarin, heightening its anti-clotting effects, which increases the risk of dangerous bleeding.

Antidote for blood thinner's side effect

There's encouraging news for people who take dabigatran (Pradaxa), a newer type of blood thinner that's had a rare side effect of uncontrolled bleeding during surgery or accidents. In October 2015, the FDA approved an antidote called idarucizumab (Praxbind), which may be able to reverse dabigatran's blood-thinning effects.

Dabigatran was approved by the FDA in 2010 and welcomed as a convenient alternative to warfarin (Coumadin) for people with certain types of atrial fibrillation, deep-vein thrombosis, or pulmonary embolism. While warfarin is generally safe and inexpensive, it takes about a week for it to become effective, and dosing is so complicated that people taking warfarin need frequent blood tests to see if the dose needs to be adjusted. Dabigatran is effective within two hours and doesn't require dose adjustment or lab monitoring. But dabigatran has caused more episodes of major bleeding than had been expected, without a way to reverse the problem.

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