In Some, Aspirin May Not Prevent Stroke
A small daily dose of aspirin is now widely accepted as a good way to prevent heart attacks and stroke, but a new British study suggests that patients with high blood pressure may not benefit from the regimen.
Researchers found that patients with uncontrolled high blood pressure, or hypertension, who take aspirin daily may be at an increased risk of bleeding from brain hemorrhages, a potentially fatal type of stroke. That risk may offset the benefits of aspirin in warding off strokes and heart attacks.
Cardiologists brought together by England’s Medical Research Council studied 5,499 men between the ages of 45 and 69 who had an increased risk of heart attack. They were divided into four groups that received one of the following therapies: aspirin and warfarin, a blood thinner; aspirin and a placebo; warfarin and a placebo; or two placebos.
The researchers reported in Saturday’s British Medical Journal (https://www.bmj.com) that aspirin reduced the incidence of heart attacks and other coronary disease by 20% for the group overall, but that the effectiveness varied with blood pressure. Aspirin reduced the incidence of heart attacks by 45% for men whose systolic blood pressure (the top number in the blood pressure reading) was less than 130 millimeters of mercury (mm Hg), but by only 6% for those whose systolic pressure was greater than 145 mm Hg.
When the risk of heart attack and stroke was combined, aspirin reduced the incidence by 41% for those with systolic pressures less than 130 mm Hg but increased the incidence by 8% for those with a pressure over 145 mm Hg. The researchers recommended that daily aspirin therapy not be given to patients with uncontrolled hypertension.
Many Patients Suffer ‘Painless’ Heart Attacks
While many people identify chest pain with heart attacks, a new study has found that as many as one-third of patients who go to a hospital because of a heart attack do not suffer pain from the seizure.
The nationwide study of 434,877 heart attack victims found that they were more likely to die because they delayed going to the hospital for up to two hours after the onset of symptoms and because doctors took longer to diagnose them.
Women, nonwhites, people older than 75 and those with previous heart failure, stroke or diabetes were most likely to suffer “painless” heart attacks, Dr. John G. Canto and his colleagues at the University of Alabama at Birmingham reported in Wednesday’s Journal of the American Medical Assn. (https://jama.ama-assn.org).
Aside from pain, the most common symptoms of a heart attack include shortness of breath, irregular heartbeat, nervousness, nausea, fainting and overwhelming weakness. Canto’s group found that 23% of those who suffered no pain died in the hospital, compared to 9% of those with the classic symptom.
Epilepsy-Like Symptoms May Have Other Causes
As many as 42% of epilepsy patients who do not respond to conventional therapy do not actually have epilepsy, according to British researchers. Instead, they have cardiovascular disease that mimics the symptoms of epilepsy, and they are not receiving appropriate treatment, the team reported in the July Journal of the American College of Cardiology (https://www-east.elsevier.com/jac/jac_mnth.htm).
Dr. Paul Cooper and his colleagues at Hope Hospital in Salford, England, studied 74 patients who were not responding to epilepsy medication. They found that the symptoms of 31 of the patients actually resulted from problems such as abnormal heart rhythm or drops in blood pressure, which caused them to faint and exhibit behaviors indistinguishable from epilepsy. When the patients were given medicine to control their cardiovascular symptoms or placed on pacemakers to control heart rates, they suffered no more seizures.
Antibiotic Could Retard Huntington’s Disease
Studies in mice suggest that a widely used antibiotic may slow the progression of Huntington’s disease.
Researchers in Boston found that the drug minocycline, a form of tetracycline used to treat acne, rheumatoid arthritis and various infections, slowed the course of the disease in mice with the same genetic defect that produces Huntington’s in humans. .
Dr. Robert M. Friedlander and his colleagues at Brigham & Women’s Hospital in Boston reported in the July Nature Medicine (https://www.nature.com/nm) that minocycline blocks the production of some enzymes, called caspases, that cause brain cells to commit suicide. Physicians must perform safety tests with the drug because of hints that it produces more side effects in mice with Huntington’s.
Study Suggests Statin Drugs Strengthen Bones
Two new studies in Wednesday’s Journal of the American Medical Assn. provide further support for the idea that cholesterol-lowering drugs called statins strengthen bones. Two studies reported last week in the international medical journal Lancet had also shown a beneficial effect from the drugs.
In one new study, researchers from University Hospital in Basil, Switzerland, analyzed data on 3,940 British patients, ages 50 through 89, who had suffered a fracture and compared them to 23,379 who had not. They found that the risk of a bone fracture was reduced by 45% in the patients taking statins.
A second study by researchers from Brigham & Women’s Hospital in Boston looked at 1,222 New Jersey patients older than 65 who had suffered a hip fracture and 4,888 who had not. They concluded that use of the statins in the 180 days before the fracture was associated with a 50% reduction in risk.
EBCT Test Questioned as Heart Risk Predictor
An imaging technique called electron-beam computed tomography, or EBCT, is increasingly being used to look for calcification of the arteries, generally considered a harbinger of heart disease and, potentially, heart attack.
But a new position paper released this week by the American College of Cardiology and the American Heart Assn. says that the test’s value has not yet been proven and that there is no compelling evidence to warrant widespread use.
The statement, published in the July Journal of the American College of Cardiology (https://www-east.elsevier.com/jac/jac_mnth.htm) and the July 4 Circulation: Journal of the American Heart Assn. (https://www.americanheart.org), says that the test has value only in limited situations, such as determining a patient’s risk level. It recommended against using the test in people without symptoms unless they have multiple risk factors for heart disease, such as high cholesterol levels, hypertension and smoking.
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Medical writer Thomas H. Maugh II can be reached at thomas.maugh@latimes.com.
