In Healthy Older Patients Aspirin Doesn’t Help

Aspirin tablets. Photo credit: Ragesoss / Wikimedia Commons
Before we delve into this month’s news about aspirin, let’s briefly review what we think we know. Aspirin is life-saving therapy during a heart attack. In patients who have had a stroke or a heart attack in the past, daily low dose aspirin can prevent a second stroke or heart attack. Ditto in patients who have had bypass surgery or angioplasty or those who have chronic angina (chest pain caused by narrowing of coronary arteries), daily low dose aspirin prevents heart attacks in them too. ...
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Heart Stents Don’t Decrease Chest Pain

“The first principle is that you must not fool yourself – and you are the easiest person to fool.” -- Richard Feynman

This month brought more bad news for coronary artery stents. To understand how far coronary stents have fallen, we have to understand what we’ve been using them for. But first I should explain that coronary stents are life-saving treatments during a heart attack. That has been well established and is not changed by anything in this post. T...
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Weighing the Risks of Celebrex

Non-steroidal anti-inflammatory medicines (NSAIDs) have been around since the 1960s. They include ibuprofen (Advil, Motrin), naproxen (Aleve), meloxicam (Mobic), diclofenac (Voltaren) and over a dozen others. NSAIDs are used to treat pain, decrease fever, and decrease inflammation. They are prescribed over 100 million times annually in the US. Naproxen and ibuprofen are also available over the counter. NSAIDs were a boon compared to the medications that were available before them. They ar...
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Less Invasive Method of Replacing Aortic Valves

The aortic valve is the valve that allows blood out of the heart into the aorta, but not back. As people get older it’s not uncommon for the aortic valve to accumulate calcium deposits, stiffen, and not open as widely. This condition is called aortic stenosis. As the aortic valve narrows, it impairs the blood flow through it. Patients can develop heart failure, lightheadedness, chest pain, and fainting. There are no effective medications for aortic stenosis. Until several years ago the only ...
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There Has Never Been a Better Time to Have Diabetes

The danger of diabetes is not only the immediate risk of very high blood sugar. Diabetes also has many dreaded long-term complications. (In this post I am referring to both type 1 and type 2 diabetes mellitus. For an explanation of the differences between these two very different diseases see the first half of this post.) Diabetes greatly increases the risk of stroke, heart attack, and amputation. In the US it is the leadin...
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What We Don’t Know About Eating Fat

Most humans have spent most of human history nearly starving to death. So it’s no surprise that we spend a lot of time thinking about food. And it’s no surprise that food has acquired cultural, social, and religious significance in almost every society. Because food is so important, and because it’s nearly impossible for us not to ascribe powerful effects to anything important to us, every society imbues special health properties to various foods. From believing that some foods are aphrod...
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On Stinting On Stents

Former President George W. Bush underwent an angioplasty this week, and the details sparked a public debate about the controversies of heart disease treatments. His spokesman stated that he underwent a routine physical exam and had no symptoms of heart disease. A stress test showed EKG changes and a CT angiogram found a blocked artery. He was transferred to another hospital and underwent an angioplasty, a procedure in which a stent (a wire mesh tube) is inserted into the blocked artery an...
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Little Evidence that Low-Salt Diet Prevents Heart Disease

We know that people with high cholesterol have a higher risk for strokes and heart attacks than people with low cholesterol. So if a medicine lowers cholesterol it should also lower the frequency of strokes and heart attacks too. Right? Not necessarily. Estrogen lowers cholesterol and doesn't lower stroke or heart attack risk. We also know that people with high blood pressure have a higher risk for strokes and heart attacks. Does that mean that a food that elevates blood pressure increases str...
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