Ask the Doctors January 2018 Issue

Ask The Doctors: January 2018

Michael Rocco, MD

Michael Rocco, MD, medical director of Cardiac Rehabilitation and Stress Testing at Cleveland Clinic

Q: What is the latest word on taking an aspirin a day to help prevent a heart attack? I’ve heard opposing ideas from two of my doctors.

A: Aspirin has long been heralded for its ability to prevent blood clots from forming. But because it thins the blood, it can cause internal bleeding or hemorrhagic stroke. Therefore, aspirin may not be for everyone. The decision to use aspirin should be made only after weighting the benefits against potential risks. Low-dose aspirin use by heart attack and stroke survivors (“secondary prevention”) can reduce the risk of a second heart attack by about 25 percent and a second stroke by 22 percent. The benefits outweigh the bleeding risks in most people who have had a prior heart attack, stroke, transient ischemic attack, peripheral arterial disease or angina, or have undergone coronary stenting or coronary artery bypass grafting. The American Diabetes Association and American Heart Association (AHA) recommend people with diabetes who are age 40 or older or who have one or more additional cardiovascular disease (CVD) risk factors take a daily aspirin (75 to 162 mg).

For the prevention of a first heart attack or stroke (“primary prevention”) in people without CVD or diabetes, the benefit-to-risk ratio of aspirin is less clear. In 2016 the U.S. Preventive Services Task Force evaluated the literature and concluded that the benefit for primary prevention outweighs the risk by a moderate amount in adults ages 50 to 59 and by a small amount in adults ages 60 to 69 who are expected to live 10 or more years, have a 10-year CVD risk estimated at 10 percent or higher and are not at increased risk of bleeding. The clinical trial evidence in adults under age 50 or age 70 or higher was insufficient, and so the balance of benefits and harms could not be determined. If you fall into one of these moderate- to high-risk groups, aspirin should be considered unless a known contraindication exists. If your CVD risk is low, or you are elderly, the bleeding risks of long-term use may outweigh the benefits.

Q: What is the truth about vitamins and supplements? Do they really promote heart health?

A: Resveratrol, turmeric, beta-carotene, coenzyme Q10, L-carnitine, arginine, red yeast rice, policosanol, hawthorn extract and vitamins such as C, B, E and folic acid have been promoted to reduce heart disease due to their antioxidant, anti-inflammatory and risk factor-lowering effects. Although some observational studies suggest possible benefit, these claims generally have not been supported in large randomized clinical trials. Also, many nutrients are potentially toxic when consumed in large quantities over a long time, and dangerous interactions exist between many supplements and prescription drugs.

Before you buy everything from vitamin A to zinc, remember that the best way to get the vitamins and minerals your body needs is to eat a balanced diet that limits excess calories, saturated fat and trans fat and is high in fresh fruits, vegetables and grains.

However, a few supplements may be considered after consulting with your physician. The AHA recommends consuming omega-3 fatty acids by eating fatty fish, such as salmon, at least twice a week, if you have no heart disease. If you have heart disease, consuming 1 gram daily from fish is recommended, although supplements may be considered if the diet is omega-3 deficient. You may need 2 to 4 grams a day of omega-3 if you have high triglyceride levels, although long-term trials to determine the benefits are ongoing.

It is reasonable to consider vitamin D supplements if blood work shows a deficiency. Until we have guidance from large, long-term studies, however, spend your money on tasty, nutritious foods and follow therapies of proven benefit—such as a healthy lifestyle and blood pressure and cholesterol medications, when appropriate—for reducing heart disease risk. 

Comments (1)

Medicare does not think it's "reasonable to consider vitamin D supplements if blood work shows a deficiency," because it won't pay for it and such a test is very expensive.

Posted by: RationalGuy | January 3, 2018 9:46 AM    Report this comment

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