Re: Re: Heart Attack and Stroke Prevention in Women

[Guest guest]

Hi All,

Could the doctors treat with anticoagulants to reduce all-cause death, as in:

Eur Heart J. 2005 Sep 5; [Epub ahead of print]

Aspirin plus warfarin compared to aspirin alone after acute coronary syndromes:

an

updated and comprehensive meta-analysis of 25 307 patients.

Andreotti F, Testa L, Biondi-Zoccai G, Crea F.

AIMS: In patients recovering from acute coronary syndromes (ACS) the role of

oral

anticoagulation (and its intensity) in addition to aspirin remains

controversial. We

conducted a specific meta-analysis of randomized trials comparing aspirin plus

warfarin (A + W) with aspirin alone in such patients. METHODS AND RESULTS:

MEDLINE

and Cochrane databases yielded 14 (of 148 potentially relevant) articles

enrolling

25 307 patients. Follow-up ranged from 3 months to 5 years. Irrespective of

International normalized ratio (INR), A + W did not significantly affect the

risk of

major adverse events (MAE: all cause death, non-fatal myocardial infarction, and

non-fatal thrombo-embolic stroke) when compared with aspirin alone [OR 0.96

(0.90-1.03), P = 0.30], but increased the risk of major bleeds (MB): OR 1.77

(1.47-2.13), P < 0.00001. However, in studies with INR of 2-3, A + W was

associated

with a significant reduction of MAE [OR 0.73 (0.63-0.84), P < 0.0001, number

needed

to treat to avoid one MAE = 33], albeit at an increased risk of MB [OR 2.32

(1.63-3.29), P < 0.00001; number needed to harm by causing one MB = 100]. In

both

analyses, intracranial bleeding was not significantly increased by A + W when

compared with aspirin alone. CONCLUSION: For patients recovering from ACS, a

combined strategy of A + W at INR values of 2-3 doubles the risk of MB, but is

nonetheless superior to aspirin alone in preventing MAE. Whether this combined

regimen is also superior to a 'double' anti-platelet strategy or to newer

evolving

treatments warrants further investigation.

PMID: 16143706?

--- citpeks <citpeks@...> wrote:

> Yesterday, I made an appointment to clean my teeth and learned that my

> dentist was no longer working because he had had a heart attack and a

> stroke. After the heart attack, he was treated with anticoagulants to

> improve blood flow, but apparently they overdosed him and he had a

> hemorrhagic stroke.

>

> The same thing happened to one of my neighbors.

>

> It makes me wonder why doctors are so aggressive in their use of

> anticoagulants.

>

> Tony

>

> ======

>

>

> >

> > Cardiology Patient Pages

> > Heart Attack and Stroke Prevention in Women

> > C. Becker

> > Circulation 2005;112 e273-e275

> >

> > Introduction

> >

> > Each year, more than one million Americans experience a heart

> attack, and nearly

> > half of them are fatal. Stroke is the leading cause of disability

> and the third

> > leading cause of death for women and men.1–3

> >

> > Heart Attack and Stroke in Women

> >

> > Many people continue to believe that heart attacks represent a

> problem targeting

> > solely older men, yet heart disease is the number one killer of both

> women and men

> > in the United States. The difference is that among men, the risk for

> heart attack

> > increases steadily after 45 years of age. In women, the risk

> increases after 50

> > years of age. However, younger women and men can also have heart

> attacks, and the

> > current epidemic of obesity and inactivity among our nation's youth

> will likely

> > shift the risk toward occurrence at younger ages over the next one

> to two decades.

> >

> > Each year, nearly 700 000 Americans experience either their first or

> second stroke,

> > and more than 20% of them are fatal. More women than men have

> strokes, and they are

> > more likely to die as a result. The problem is particularly serious

> in black

> > Americans.4–8

> >

> > Who Is at Risk?

> >

> > Being familiar with factors that increase the risk for either a

> heart attack or

> > stroke is the first step toward prevention. If you have one or more

> of these

> > factors, please contact your healthcare provider to discuss the

> available means to

> > reduce the risk.

> >

> > What Are the Signs and Symptoms?

> >

> > In most instances, a heart attack or stroke is caused by a small

> blood clot lodged

> > within a blood vessel leading to either the heart or brain (see the

> Figure). The

> > lack of blood (and oxygen) causes injury, which increases steadily

> over time;

> > therefore, prompt recognition and medical treatment are of utmost

> importance.

> >

> > Fig: Blood clots forming in the blood vessels serving the heart

> cause heart

> > attacks; those that develop in or travel to the blood vessels in the

> brain are

> > responsible for strokes.

> >

> > The signs and symptoms of heart attack and stroke are listed in the

> boxes. It is

> > important to remember that they can differ from one person to

> another and may " wax

> > and wane " with time. If you are not sure, it is better to seek

> medical advice than

> > to wait.

> >

> > Warning Signs for Stroke

> >

> > Sudden weakness or numbness of face or limb on one side.

> > Sudden, severe headache.

> > Difficulty talking or understanding speech.

> > Unexplained dizziness.

> > Sudden dimness/loss of vision, often in one eye.

> > Warning Signs for Heart Attack

> > Chest discomfort: uncomfortable pressure, squeezing or fullness.

> > Discomfort in other areas of the upper body: one or both arms or in

> the back, neck,

> > jaw, or stomach.

> > Shortness of breath, either with chest discomfort or alone.

> > Other signs, including nausea, lightheadedness, or breaking out in a

> cold sweat.

> >

> > Risk Factors for Stroke

> >

> > High blood pressure.

> > Diabetes.

> > High cholesterol.

> > Age (risk doubles for each decade over 55 years of age).

> > Family history of stroke.

> > Smoking.

> > Birth control pills.

> > Atrial fibrillation.

> > Heart failure.

> > Excess alcohol.

> > Prior stroke or heart attack.

> > Black race.

> > Gender (women are at greater risk than men).

> >

> > Risk Factors for Heart Attack

> >

> > High blood pressure.

> > Diabetes.

> > Smoking.

> > High cholesterol.

> > Age.

> > Hormone replacement therapy.

> > Physical inactivity.

> > Gender (men are at greater risk than women).

> >

> > Prevention of Heart Attack and Stroke

> >

> > Stop smoking.

> >

> > Engage in physical activity.

> > Use diet therapy.

> > Maintain/reduce weight.

> > Control blood pressure.

> > Undergo cholesterol control/statin therapy.

> > Control blood sugar.

> > Limit alcohol intake.

> > Take aspirin as advised.*

> > =========================

> > *For women who have at least a 20% chance of a heart attack or

> stroke over the next

> > 10 years.

> >

> > How Aware Are You?

> >

> > A recent American Heart Association–sponsored telephone survey of

> more than 1000

> > women who were over 25 years of age found that only 1 of every 3

> women correctly

> > identified the warning signs of stroke. Awareness of heart attack

> risk is low

> > nationwide but was particularly low among Hispanic and black women.

> >

> > There has been an overall improvement in the level of awareness

> among American women

> > over the past decade. Both a clear need and a large margin for

> improvement exist,

> > however, for national and community prevention programs to develop

> educational

> > programs directed toward those at greatest risk.9

> >

> > How Can I Reduce My Chances of Having a Heart Attack or Stroke?

> > Rather than consider heart and blood vessel disease as a

> " have-or-have-not "

> > condition, the medical community now looks at a " continuum of risk "

> that requires

> > intermittent appraisal by healthcare providers. Your physician can

> assess the chance

> > of your having a heart attack or stroke according to risk prediction

> charts and can

> > optimize strategies of preventive care.10,11 It is important for all

> women to

> > recognize the important role that they themselves play in preventing

> heart attack

> > and stroke by following a healthy lifestyle.12

> >

> > Is Aspirin for Everyone?

> >

> > In low doses, aspirin reduces " sticking " of blood platelets to one

> another,

> > preventing blood clots. A study of nearly 40 000 initially healthy

> women 45 years of

> > age or older13 found that aspirin (100 milligrams every other day)

> reduced the risk

> > of a first stroke by nearly 25%, and in women over 65 years of age,

> it decreased the

> > likelihood of both heart attack and stroke. On the flip side,

> aspirin increased by

> > 40% the risk of bleeding within the stomach and intestines, a known

> side effect.

> >

> > What is the take-home message for women? Low-dose aspirin reduces

> heart attack and

> > stroke for women at high risk and for those over 65 years of age.

> The balance of

> > benefit with the risk of bleeding must be weighed carefully for each

> individual and

> > discussed with a healthcare professional.

> >

> > It must be emphasized that women with a prior heart attack or stroke

> are known to

> > benefit from daily aspirin.

> >

> > Are All the Answers About Aspirin in?

> >

> > The wide-scale availability, low cost, and proven benefits of

> aspirin make it a

> > topic of great interest and importance in public health. Women at

> low risk for a

> > heart attack or stroke do not benefit from regular aspirin use.

> Similarly, it has

> > been established that women at high risk benefit considerably. The

> questions that

> > remain unanswered are as follows:

> >

> > What is the role of aspirin among women at intermediate risk (10% to

> 20% risk over a

> > 10-year period) for a stroke or heart attack?

> >

> > What is the safest and most effective dose of aspirin?

> >

> > Does the optimal dose of aspirin differ from one person to another?

> >

> > Do the protective effects of aspirin differ between women and men?

> If so, how can

> > the difference be explained and translated to health care?

> >

> > Can a simple blood test like C-reactive protein identify healthy

> people who are

> > likely to benefit from aspirin?

> >

> > Answers to these questions require additional research.

> >

> > What Should I Do if I Experience Signs or Symptoms of a Heart Attack

> or Stroke?

> >

> > Time is of the essence. Treatments to restore the flow of blood (and

> oxygen) to the

> > brain and heart are available but are most beneficial when used in

> the first several

> > hours. Call 9-1-1. By calling 9-1-1 and taking an ambulance to the

> hospital where

> > heart attack and stroke care is available, you substantially

> increase your chances

> > of recovery. Remember, you should never drive yourself to the

> hospital unless there

> > is absolutely no other choice.

> >

> > Knowing how to prevent a heart attack or stroke, and being prepared

> to act

> > immediately if you experience the signs or symptoms of either one,

> could save your

> > life.

> >

> > Footnotes

> >

> > The information contained in this Circulation Cardiology Patient

> Page is not a

> > substitute for medical advice or treatment, and the American Heart

> Association

> > recommends consultation with your doctor or healthcare professional.

> >

> > Al Pater, PhD; email: old542000@y...

> >

> >

> >

> > __________________________________

> > FareChase: Search multiple travel sites in one click.

> > http://farechase.

> >

>

>

>

>

>

Al Pater, PhD; email: old542000@...

__________________________________

Start your day with - Make it your home page!

http://www./r/hs

[Guest guest]

Hi All,

Could the doctors treat with anticoagulants to reduce all-cause death, as in:

Eur Heart J. 2005 Sep 5; [Epub ahead of print]

Aspirin plus warfarin compared to aspirin alone after acute coronary syndromes:

an

updated and comprehensive meta-analysis of 25 307 patients.

Andreotti F, Testa L, Biondi-Zoccai G, Crea F.

AIMS: In patients recovering from acute coronary syndromes (ACS) the role of

oral

anticoagulation (and its intensity) in addition to aspirin remains

controversial. We

conducted a specific meta-analysis of randomized trials comparing aspirin plus

warfarin (A + W) with aspirin alone in such patients. METHODS AND RESULTS:

MEDLINE

and Cochrane databases yielded 14 (of 148 potentially relevant) articles

enrolling

25 307 patients. Follow-up ranged from 3 months to 5 years. Irrespective of

International normalized ratio (INR), A + W did not significantly affect the

risk of

major adverse events (MAE: all cause death, non-fatal myocardial infarction, and

non-fatal thrombo-embolic stroke) when compared with aspirin alone [OR 0.96

(0.90-1.03), P = 0.30], but increased the risk of major bleeds (MB): OR 1.77

(1.47-2.13), P < 0.00001. However, in studies with INR of 2-3, A + W was

associated

with a significant reduction of MAE [OR 0.73 (0.63-0.84), P < 0.0001, number

needed

to treat to avoid one MAE = 33], albeit at an increased risk of MB [OR 2.32

(1.63-3.29), P < 0.00001; number needed to harm by causing one MB = 100]. In

both

analyses, intracranial bleeding was not significantly increased by A + W when

compared with aspirin alone. CONCLUSION: For patients recovering from ACS, a

combined strategy of A + W at INR values of 2-3 doubles the risk of MB, but is

nonetheless superior to aspirin alone in preventing MAE. Whether this combined

regimen is also superior to a 'double' anti-platelet strategy or to newer

evolving

treatments warrants further investigation.

PMID: 16143706?

--- citpeks <citpeks@...> wrote:

> Yesterday, I made an appointment to clean my teeth and learned that my

> dentist was no longer working because he had had a heart attack and a

> stroke. After the heart attack, he was treated with anticoagulants to

> improve blood flow, but apparently they overdosed him and he had a

> hemorrhagic stroke.

>

> The same thing happened to one of my neighbors.

>

> It makes me wonder why doctors are so aggressive in their use of

> anticoagulants.

>

> Tony

>

> ======

>

>

> >

> > Cardiology Patient Pages

> > Heart Attack and Stroke Prevention in Women

> > C. Becker

> > Circulation 2005;112 e273-e275

> >

> > Introduction

> >

> > Each year, more than one million Americans experience a heart

> attack, and nearly

> > half of them are fatal. Stroke is the leading cause of disability

> and the third

> > leading cause of death for women and men.1–3

> >

> > Heart Attack and Stroke in Women

> >

> > Many people continue to believe that heart attacks represent a

> problem targeting

> > solely older men, yet heart disease is the number one killer of both

> women and men

> > in the United States. The difference is that among men, the risk for

> heart attack

> > increases steadily after 45 years of age. In women, the risk

> increases after 50

> > years of age. However, younger women and men can also have heart

> attacks, and the

> > current epidemic of obesity and inactivity among our nation's youth

> will likely

> > shift the risk toward occurrence at younger ages over the next one

> to two decades.

> >

> > Each year, nearly 700 000 Americans experience either their first or

> second stroke,

> > and more than 20% of them are fatal. More women than men have

> strokes, and they are

> > more likely to die as a result. The problem is particularly serious

> in black

> > Americans.4–8

> >

> > Who Is at Risk?

> >

> > Being familiar with factors that increase the risk for either a

> heart attack or

> > stroke is the first step toward prevention. If you have one or more

> of these

> > factors, please contact your healthcare provider to discuss the

> available means to

> > reduce the risk.

> >

> > What Are the Signs and Symptoms?

> >

> > In most instances, a heart attack or stroke is caused by a small

> blood clot lodged

> > within a blood vessel leading to either the heart or brain (see the

> Figure). The

> > lack of blood (and oxygen) causes injury, which increases steadily

> over time;

> > therefore, prompt recognition and medical treatment are of utmost

> importance.

> >

> > Fig: Blood clots forming in the blood vessels serving the heart

> cause heart

> > attacks; those that develop in or travel to the blood vessels in the

> brain are

> > responsible for strokes.

> >

> > The signs and symptoms of heart attack and stroke are listed in the

> boxes. It is

> > important to remember that they can differ from one person to

> another and may " wax

> > and wane " with time. If you are not sure, it is better to seek

> medical advice than

> > to wait.

> >

> > Warning Signs for Stroke

> >

> > Sudden weakness or numbness of face or limb on one side.

> > Sudden, severe headache.

> > Difficulty talking or understanding speech.

> > Unexplained dizziness.

> > Sudden dimness/loss of vision, often in one eye.

> > Warning Signs for Heart Attack

> > Chest discomfort: uncomfortable pressure, squeezing or fullness.

> > Discomfort in other areas of the upper body: one or both arms or in

> the back, neck,

> > jaw, or stomach.

> > Shortness of breath, either with chest discomfort or alone.

> > Other signs, including nausea, lightheadedness, or breaking out in a

> cold sweat.

> >

> > Risk Factors for Stroke

> >

> > High blood pressure.

> > Diabetes.

> > High cholesterol.

> > Age (risk doubles for each decade over 55 years of age).

> > Family history of stroke.

> > Smoking.

> > Birth control pills.

> > Atrial fibrillation.

> > Heart failure.

> > Excess alcohol.

> > Prior stroke or heart attack.

> > Black race.

> > Gender (women are at greater risk than men).

> >

> > Risk Factors for Heart Attack

> >

> > High blood pressure.

> > Diabetes.

> > Smoking.

> > High cholesterol.

> > Age.

> > Hormone replacement therapy.

> > Physical inactivity.

> > Gender (men are at greater risk than women).

> >

> > Prevention of Heart Attack and Stroke

> >

> > Stop smoking.

> >

> > Engage in physical activity.

> > Use diet therapy.

> > Maintain/reduce weight.

> > Control blood pressure.

> > Undergo cholesterol control/statin therapy.

> > Control blood sugar.

> > Limit alcohol intake.

> > Take aspirin as advised.*

> > =========================

> > *For women who have at least a 20% chance of a heart attack or

> stroke over the next

> > 10 years.

> >

> > How Aware Are You?

> >

> > A recent American Heart Association–sponsored telephone survey of

> more than 1000

> > women who were over 25 years of age found that only 1 of every 3

> women correctly

> > identified the warning signs of stroke. Awareness of heart attack

> risk is low

> > nationwide but was particularly low among Hispanic and black women.

> >

> > There has been an overall improvement in the level of awareness

> among American women

> > over the past decade. Both a clear need and a large margin for

> improvement exist,

> > however, for national and community prevention programs to develop

> educational

> > programs directed toward those at greatest risk.9

> >

> > How Can I Reduce My Chances of Having a Heart Attack or Stroke?

> > Rather than consider heart and blood vessel disease as a

> " have-or-have-not "

> > condition, the medical community now looks at a " continuum of risk "

> that requires

> > intermittent appraisal by healthcare providers. Your physician can

> assess the chance

> > of your having a heart attack or stroke according to risk prediction

> charts and can

> > optimize strategies of preventive care.10,11 It is important for all

> women to

> > recognize the important role that they themselves play in preventing

> heart attack

> > and stroke by following a healthy lifestyle.12

> >

> > Is Aspirin for Everyone?

> >

> > In low doses, aspirin reduces " sticking " of blood platelets to one

> another,

> > preventing blood clots. A study of nearly 40 000 initially healthy

> women 45 years of

> > age or older13 found that aspirin (100 milligrams every other day)

> reduced the risk

> > of a first stroke by nearly 25%, and in women over 65 years of age,

> it decreased the

> > likelihood of both heart attack and stroke. On the flip side,

> aspirin increased by

> > 40% the risk of bleeding within the stomach and intestines, a known

> side effect.

> >

> > What is the take-home message for women? Low-dose aspirin reduces

> heart attack and

> > stroke for women at high risk and for those over 65 years of age.

> The balance of

> > benefit with the risk of bleeding must be weighed carefully for each

> individual and

> > discussed with a healthcare professional.

> >

> > It must be emphasized that women with a prior heart attack or stroke

> are known to

> > benefit from daily aspirin.

> >

> > Are All the Answers About Aspirin in?

> >

> > The wide-scale availability, low cost, and proven benefits of

> aspirin make it a

> > topic of great interest and importance in public health. Women at

> low risk for a

> > heart attack or stroke do not benefit from regular aspirin use.

> Similarly, it has

> > been established that women at high risk benefit considerably. The

> questions that

> > remain unanswered are as follows:

> >

> > What is the role of aspirin among women at intermediate risk (10% to

> 20% risk over a

> > 10-year period) for a stroke or heart attack?

> >

> > What is the safest and most effective dose of aspirin?

> >

> > Does the optimal dose of aspirin differ from one person to another?

> >

> > Do the protective effects of aspirin differ between women and men?

> If so, how can

> > the difference be explained and translated to health care?

> >

> > Can a simple blood test like C-reactive protein identify healthy

> people who are

> > likely to benefit from aspirin?

> >

> > Answers to these questions require additional research.

> >

> > What Should I Do if I Experience Signs or Symptoms of a Heart Attack

> or Stroke?

> >

> > Time is of the essence. Treatments to restore the flow of blood (and

> oxygen) to the

> > brain and heart are available but are most beneficial when used in

> the first several

> > hours. Call 9-1-1. By calling 9-1-1 and taking an ambulance to the

> hospital where

> > heart attack and stroke care is available, you substantially

> increase your chances

> > of recovery. Remember, you should never drive yourself to the

> hospital unless there

> > is absolutely no other choice.

> >

> > Knowing how to prevent a heart attack or stroke, and being prepared

> to act

> > immediately if you experience the signs or symptoms of either one,

> could save your

> > life.

> >

> > Footnotes

> >

> > The information contained in this Circulation Cardiology Patient

> Page is not a

> > substitute for medical advice or treatment, and the American Heart

> Association

> > recommends consultation with your doctor or healthcare professional.

> >

> > Al Pater, PhD; email: old542000@y...

> >

> >

> >

> > __________________________________

> > FareChase: Search multiple travel sites in one click.

> > http://farechase.

> >

>

>

>

>

>

Al Pater, PhD; email: old542000@...

__________________________________

Start your day with - Make it your home page!

http://www./r/hs

[Guest guest]

As I understand it, it's because ischemic stroke is more common then hemorrhagic.

Hemo becoming more common after like 80yo.

Regards.

[ ] Re: Heart Attack and Stroke Prevention in Women

Yesterday, I made an appointment to clean my teeth and learned that mydentist was no longer working because he had had a heart attack and astroke. After the heart attack, he was treated with anticoagulants toimprove blood flow, but apparently they overdosed him and he had ahemorrhagic stroke.The same thing happened to one of my neighbors. It makes me wonder why doctors are so aggressive in their use ofanticoagulants.Tony

[Guest guest]

As I understand it, it's because ischemic stroke is more common then hemorrhagic.

Hemo becoming more common after like 80yo.

Regards.

[ ] Re: Heart Attack and Stroke Prevention in Women

Yesterday, I made an appointment to clean my teeth and learned that mydentist was no longer working because he had had a heart attack and astroke. After the heart attack, he was treated with anticoagulants toimprove blood flow, but apparently they overdosed him and he had ahemorrhagic stroke.The same thing happened to one of my neighbors. It makes me wonder why doctors are so aggressive in their use ofanticoagulants.Tony

[Guest guest]

Just for the hell of it, what would you do if you suddenly found you couldn't write in your notebook? This actually happened to a friend of mine (92yo). He was at a gas station and had just filled the tank and couldn't make an entry in his log.

What he did was drive home and hope it goes away - a lot of people use that approach, at first.

Then he called a doc, but the doc he hadn't been to in so long was out of business - really. So he tried a few others until he found one he could see - in a few days. That guy set him up for a carotid artery scan, but that took like 2 weeks to get him in.

So finally they determined he needed some drugs for a stroke. He lived about 6 months after that.

Is that like maybe NOT throwing yourself into the "maw of modern medicine"? Is that cautious?

I think if I encounter a like situation, I'll go directly to the hospital. Houston TMC, if I can get that far.

And BTW, exercise fans, he kept a garden roto-tilled every year up to that event. He was a thin person his whole life.

Regards.

[ ] Re: Heart Attack and Stroke Prevention in Women Yesterday, I made an appointment to clean my teeth and learned that mydentist was no longer working because he had had a heart attack and astroke. After the heart attack, he was treated with anticoagulants toimprove blood flow, but apparently they overdosed him and he had ahemorrhagic stroke.The same thing happened to one of my neighbors. It makes me wonder why doctors are so aggressive in their use ofanticoagulants.Tony

[Guest guest]

Just for the hell of it, what would you do if you suddenly found you couldn't write in your notebook? This actually happened to a friend of mine (92yo). He was at a gas station and had just filled the tank and couldn't make an entry in his log.

What he did was drive home and hope it goes away - a lot of people use that approach, at first.

Then he called a doc, but the doc he hadn't been to in so long was out of business - really. So he tried a few others until he found one he could see - in a few days. That guy set him up for a carotid artery scan, but that took like 2 weeks to get him in.

So finally they determined he needed some drugs for a stroke. He lived about 6 months after that.

Is that like maybe NOT throwing yourself into the "maw of modern medicine"? Is that cautious?

I think if I encounter a like situation, I'll go directly to the hospital. Houston TMC, if I can get that far.

And BTW, exercise fans, he kept a garden roto-tilled every year up to that event. He was a thin person his whole life.

Regards.

[ ] Re: Heart Attack and Stroke Prevention in Women Yesterday, I made an appointment to clean my teeth and learned that mydentist was no longer working because he had had a heart attack and astroke. After the heart attack, he was treated with anticoagulants toimprove blood flow, but apparently they overdosed him and he had ahemorrhagic stroke.The same thing happened to one of my neighbors. It makes me wonder why doctors are so aggressive in their use ofanticoagulants.Tony