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Asprin and Heart Disease

“Approximately 25 percent of the reduction in the rate of death from coronary artery disease that has occurred during the past 30 years may be explained by the practice of primary prevention,” says Dr. Michael Lauer, of Cleveland Clinic Foundation, in an article in the New England Journal of Medicine (NEJM).

What is primary prevention?

Primary prevention involves a deliberate treatment of a person with established risk factors for heart disease although the person has no clinical symptoms or other evidence of heart disease. The purpose is to prevent cardiac events like heart attack.

What are the risk factors for heart disease which can be target of primary prevention?

There are several of them: high blood pressure, smoking, high cholesterol level, sedentary (much sitting and little exercise) life style, platelet activity (a type of blood cell which can stick together and block coronary arteries) and inflammation.

Family history of heart disease is a risk factor as well but there is not much you can do to change that!

What is the role of aspirin in primary prevention?

Aspirin has both anti-platelet and anti-inflammatory effects. In 1970s, studies suggested regular aspirin use could reduce the risk of heart attack and death from coronary artery disease, says the NEJM article. More recent studies have confirmed this although many aspects of aspirin use are uncertain.

The article’s conclusions are:

-Aspirin use probably reduces the risk of heart attack in men over the age 50 years. It is unclear whether women have the same sort of benefit as men.
-The decision to initiate aspirin therapy should be based on assessment of absolute risk of a heart attack.
-For prevention of heart attack, low doses of aspirin (100 mg per day or less) are adequate. For prevention of stroke, low-dose aspirin is just as effective as high-dose therapy.
-Observational studies have suggested that aspirin may prevent cancer of the colon, esophagus, stomach, and rectum. But this has not been confirmed.
-Aspirin use can cause bleeding. Most common site of major bleeding (bleeding leading to death, transfusion, or surgery) was the gastrointestinal tract. It can cause minor bleeding like nose bleeds and bruising as well.

Aspirin is also called Acetylsalicylic Acid, derivative of salicylic acid that is a mild, non-narcotic pain killer useful in the relief of headache and muscle and joint aches. Aspirin is also effective in reducing fever, inflammation, and swelling and thus has been used for treatment of rheumatoid arthritis, rheumatic fever, and mild infection.

German chemical and pharmaceutical company founded in 1863 by a chemical salesman, Friedrich Bayer (1825-80), and now operating plants in Germany and more than 30 other countries was the first developer and marketer of aspirin (1899), says Encyclopædia Britannica

Aspirin has been with us for over hundred years. It is cheap and universally available. It has many health benefits. But it is not completely safe. So, before you start taking aspirin, talk to your doctor. See if it is safe for you. And don’t forget other risk factors which require your attention. Help your doctor keep you healthy!

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Peanut Allergies in a Nutshell

In the last column, we discussed some important aspects of peanut allergy. Today, we will concentrate on prevention, immediate management and where to find more information on this important subject.

As in the last column, we will use information provided by Dr. Hugh Sampson, paediatrician, Mount Sinai School of Medicine, New York, in his article published in the New England Journal of Medicine.

Sharon Pudwell, a local parent of a child with peanut allergy, has also given me information to share with you.

Dr. Sampson says that children with peanut allergy, their parents and caregivers, must be educated to:

-to avoid accidentally ingesting peanuts
-learn to recognize early signs of an allergic reaction
-learn to give medication as soon as symptoms develop.

Parents and children should check all food labels. They should avoid high-risk situations such as foods served in buffets and ice-cream parlours and unlabeled candies and deserts.

Symptoms of allergic reaction can appear within few minutes to few hours. Pudwell says that some of the early symptoms are: itchy eyes, nose, and face; flushing of face and body; swelling of eyes, face, lips, tongue and throat; hives, vomiting, diarrhoea, wheezing, a feeling of fear and apprehension; weakness and dizziness; inability to breathe and eventually loss of consciousness. The condition may end in shock and death.

Treatment of acute reaction (anaphylaxis) by patient and family members include injection of epinephrine (depending on patient’s history and symptoms) with EpiPen Autoinjector and oral liquid diphenhydramine (an anti-allergic medication). Patient should be transported to hospital emergency immediately. Let emergency physician take over the care. Patients should be observed in the emergency department for at least four hours after they have recovered.

Dr. Sampson says that considerable amount of education material is available from the Food Allergy and Anaphylaxis Network (telephone number, 1-800-929-4040; web site www.foodallergy.org). This web site contains written emergency plan (every allergic child should carry one) and appropriate doses of liquid diphenhydramine and self-injectable epinephrine

Locally, Pudwell had started a support group. She says, “My support group no longer meets. I do not know personally how many people in this area suffer from peanut allergies. I still take an active part in education (in schools) and am available to anyone who would require support”.

She adds, “You can give my name and phone number (527-0997). Here are a few sites I use for up-to-date information: www.peanutallergy.com; www.cadvision.com/allergy; www.anaphylaxis.org. These are all excellent web sites for resources, alerts, food recalls, and discussion boards”.

Pudwell suggests the following rules:
-carry Epi-pen
-wear a medical alert bracelet
-carry a cell phone
-do not ever share foods – eat only foods you have prepared yourself or in a child’s case only food your parents have prepared for you.
-read and re-read labels
-be aware of your surrounding

Pudwell says, “To believe that the world can be free of peanuts is unrealistic, or to single out a child as somehow not quite equal to another because of allergies is unfair. We believe children must learn to live with the knowledge of their allergies, and be taught from a very young age the coping skills they will need for a safe and healthy survival”.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Peanut Allergies

Did you know that the majority of fatal and near-fatal allergic reactions in North America are caused by peanut allergy?

The subject of peanut allergy is very important to parents, school administrators and anybody who looks after children. It is time to revisit the subject.

Food allergy affects about six to eight percent of children younger than four years of age. It can affect older children as well.

Peanuts have been with us since they were first cultivated in South America about 2000 to 3000 B.C. But allergy to peanut appears to be a phenomenon of the past two decades.

April 25th issue of the New England Journal of Medicine deals with this subject quite nicely. The author of the article is Dr. Hugh Sampson, Paediatrician from Mount Sinai School of Medicine, New York. Here are some important points from the article:

-In spite of increasing public awareness of food allergy, most patients are not well prepared to deal with severe allergic reactions. Over 80 percent of patients who died from allergic reactions to food were not given appropriate information to avoid accidental food-induced reactions or use self-injectable epinephrine.

-Food-induced severe allergic reaction is often mistaken for severe attack of asthma or an acute cardiac event. Therefore, taking careful history of exposure to an allergen is important. There is no laboratory test to diagnose allergic reaction to food.

-Initial symptoms of peanut or food allergy are: tingling in the mouth and lips, sensation of tightening of the wind pipe, colicky abdominal pain, and nausea and vomiting, flushing of the skin, etc.

-Delay in the initiation of therapy such as injectable epinephrine is associated with a poorer prognosis, although about 10 percent of patients who receive epinephrine early still die.

-Up to one third of patients have a biphasic reaction – that is, these patients seem to have fully recovered when severe spasm of the airway suddenly recurs, requiring patient to go on a breathing machine. This usually occurs within the first four hours of initial treatment and recovery. So all patients should be observed in the hospital at least for four hours after they have successfully responded to initial treatment.

-In 25 to 35 percent of patients with peanut allergy, an allergic reaction to tree nuts (such as walnuts, cashews, and pistachios) will develop even though tree nuts are from a different botanical family.

-In vast majority of the patients the first reaction to peanuts occurs at a median age of 14 months. Many food allergies in children disappear as they grow. But peanut allergy often is a lifelong disorder.

In the next column, we will discuss what parents should do to teach their children about peanut and other food allergies. We will also tell you where to find more information on this subject.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Fish and Omega-3 Fatty Acids

Fish on Monday, fish on Tuesday, fish on Wednesday, fish on Thursday, fish on Friday, fish on Saturday, a…n…d fish on Sunday!

What would happen to me if I eat all that fish?

There are several possibilities! I may turn into a fish. I may smell like a fish. I may incite my wife to throw me out of our smelly fishy house. My neighbours may name my residence as “House of Fish”. Or I may reduce my risk of getting a sudden heart attack!

What’s the right answer? Let us find out.

Within a month, two articles appeared on the advantages of consuming more fish each week (not necessarily everyday!). The first one appeared in the Canadian Medical Association Journal (CMAJ) titled – Omega-3 fatty acids in cardiovascular care. The second one in the New England Journal of Medicine (NEJM) titled – Food to Calm the Heart.

Fish and fish oils have omega-3 fatty acids. Also known as n-3 fatty acids. Whole grains, beans, seaweed, and soybean products also contain omega-3 fatty acids.

Eskimos have extremely low rates of death from heart disease because they eat lot of fish. Mediterranean diet is also high in omega-3 fatty acids.

A typical North American diet includes about one fish serving every 10 days. That is about 130 mg/day of omega-3 fatty acids. That is not enough.

Consumption of more fish does not stop one having heart disease. But it does help reduce the incidence of sudden heart attack. Studies have shown that if fish is fed to people who have had a heart attack, then fish can reduce the risk of sudden death by 45 percent.

But what about those who have had no previous heart problems?

The answer to this question is found in a study published in the recent NEJM. The authors studied 22,071 male physicians who were 40 to 84 years old in 1982 and had no history of a heart attack, stroke, or cancer. Their dietary intake of fish was studied, with measurements of blood n-3 fatty acids, and documentation of any cardiac problems during the 17 years of follow-up.

They found that the n-3 fatty acids found in fish are strongly associated with a reduced risk of sudden death among men who had no evidence of prior heart disease.

This information is important, as it is known that 50 percent of all sudden deaths from cardiac causes occur in people with no history of heart disease. Death is usually from irregular heart rhythm or coronary heart disease. Preventive measures (by way of increased consumption of fish) would help.

There is some evidence to suggest that consumption of fish may contribute to lower colon and rectal cancer, and breast cancer.

Next question is: how much fish should we eat and how often?

American Heart Association recommends at least two servings of fish per week, especially fatty fish (salmon, bluefish, mackerel, arctic, char, and swordfish).

The CMAJ article recommends three servings of fish per week. Eat fish that is broiled or baked. Avoid breaded fish products, fish sticks, fish and chips, and heavily salted or pickled fish. These are heavily loaded with unhealthy fat.

You can take fish oil capsules with meals. Or liquid egg enriched in mega-3 fatty acids. Vegetarians can find benefit from vegetable oils, nuts and seeds. We should strive for an intake of one gram per day of n-3 fatty acids.

Remember, heart disease is the number one killer in the industrialized world. If eating fish is going to save our population and civilization then let us eat fish on Monday, fish on Wednesday, fish on Friday, golf on Saturday, and go fishing on Sunday!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!