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Have Family History Of Hypertension, Transient Ischemic Attack And Stroke. Should I Take Aspirin As Precautionary Measures?
Question: Hi,
I am 50 years old man, height 177 Cm, weight 76 Kg, active, do workout one and a half hour everyday to 30Kms/Week on walking. BP, Sugar and other Vital signs are normal. However their is a history of hypertension, TIA(transient ischemic attack) and stroke in my family. To both my father and mother have stroke, TIA and suffered from hypertension. My father died of blood cancer at the age of 88, my mother is currently 86 years old under the circumstances would you recommend that i take precautionatly mild dose of Aspirin as a prevention for TIA if yes what is the dosage and frequency to recommend, if no please explain why not and what precaution should i take to prevent occurrence of TIA.
I am 50 years old man, height 177 Cm, weight 76 Kg, active, do workout one and a half hour everyday to 30Kms/Week on walking. BP, Sugar and other Vital signs are normal. However their is a history of hypertension, TIA(transient ischemic attack) and stroke in my family. To both my father and mother have stroke, TIA and suffered from hypertension. My father died of blood cancer at the age of 88, my mother is currently 86 years old under the circumstances would you recommend that i take precautionatly mild dose of Aspirin as a prevention for TIA if yes what is the dosage and frequency to recommend, if no please explain why not and what precaution should i take to prevent occurrence of TIA.
Brief Answer:
Not indicated in most patients, provide details.
Detailed Answer:
Dear Sir
1. The role of aspirin in primary prophylaxis (prevention in patients where no event has taken place as yet) is controversial. Going by current thinking, literature and expert opinions it is not advisable in most of the patients. Especially the risk reduction in stroke was never proven/ TIA. Most of the benefit derived from aspirin was from reduction in non-fatal heart attacks and it does not provide benefit in stroke reduction. However the reduction in heart attacks was offset by increase in risk for gastro-intestinal bleeding. So overall current thinking do not favor its use for primary prophylaxis.
2. Still I would like to know a few things from you and calculate your 10 year risk for Cardiovascular events. I wish to know your total cholesterol level, HDL cholesterol level, usual blood pressure reading. If you had chronic kidney disease, atrial fibrillation, diabetes, smoking or family history of angina (age of relative at onset also required) and your ethinicity.
3. Please tell all your current medications (especially for blood pressure). If you ever had bleeding form stomach or had black stools or had history of frequent dyspepsia.
Once You provide this information, I would calculate your risk and provide you more insight into the issue.
Sincerely
Sukhvinder
Not indicated in most patients, provide details.
Detailed Answer:
Dear Sir
1. The role of aspirin in primary prophylaxis (prevention in patients where no event has taken place as yet) is controversial. Going by current thinking, literature and expert opinions it is not advisable in most of the patients. Especially the risk reduction in stroke was never proven/ TIA. Most of the benefit derived from aspirin was from reduction in non-fatal heart attacks and it does not provide benefit in stroke reduction. However the reduction in heart attacks was offset by increase in risk for gastro-intestinal bleeding. So overall current thinking do not favor its use for primary prophylaxis.
2. Still I would like to know a few things from you and calculate your 10 year risk for Cardiovascular events. I wish to know your total cholesterol level, HDL cholesterol level, usual blood pressure reading. If you had chronic kidney disease, atrial fibrillation, diabetes, smoking or family history of angina (age of relative at onset also required) and your ethinicity.
3. Please tell all your current medications (especially for blood pressure). If you ever had bleeding form stomach or had black stools or had history of frequent dyspepsia.
Once You provide this information, I would calculate your risk and provide you more insight into the issue.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Total cholesterol level, HDL cholesterol levels are below critical limits within normal range, blood pressure readings are always normal i.e. 120/80.
I don't have chronic kidney disease, atrial fibrillation, diabetes or family history of angina.
I never had bleeding form stomach or had black stools or had history of frequent dyspepsia.
Currently i am not taking any medication.
I smoke less than 10 cigarettes in a day and less than 10 pegs in a week.
I don't have chronic kidney disease, atrial fibrillation, diabetes or family history of angina.
I never had bleeding form stomach or had black stools or had history of frequent dyspepsia.
Currently i am not taking any medication.
I smoke less than 10 cigarettes in a day and less than 10 pegs in a week.
Brief Answer:
STOP SMOKING.
Detailed Answer:
Respected Sir
1. If you could have provided me the exact values for cholesterol levels, it would have been better. However putting roughly normal values in risk calculators, it gives us a risk of ~6-12% by various calculators. Typically we used to put patients on aspirin (for primary prophylaxis of heart attacks) when risk was in the range of 6-10% but not now. Moreover your main concern is not heart attack but stroke. For stroke there is no conclusive data of any benefit .
2. The best way to reduce risk of heart attack as well as stroke/ TIA in your case is to stop smoking altogether. If I recalculate your risk after removing smoking from your profile, it comes to less than half of baseline value. Hence , once you stop smoking , you are not a candidate for primary aspirin prophylaxis, even by old criteria.
3. Please keep your blood pressure/ cholesterol with in normal range. Do not smoke at all. Continue with your workout, as you are doing. Keep yourself stress free. Reduce your alcohol intake to 1-2 pegs a day. (e.g. it is not good if one is taking 5 pegs a day, twice a week).
Hope this helps.
Feel free to discuss further.
Sincerely
Sukhvinder
STOP SMOKING.
Detailed Answer:
Respected Sir
1. If you could have provided me the exact values for cholesterol levels, it would have been better. However putting roughly normal values in risk calculators, it gives us a risk of ~6-12% by various calculators. Typically we used to put patients on aspirin (for primary prophylaxis of heart attacks) when risk was in the range of 6-10% but not now. Moreover your main concern is not heart attack but stroke. For stroke there is no conclusive data of any benefit .
2. The best way to reduce risk of heart attack as well as stroke/ TIA in your case is to stop smoking altogether. If I recalculate your risk after removing smoking from your profile, it comes to less than half of baseline value. Hence , once you stop smoking , you are not a candidate for primary aspirin prophylaxis, even by old criteria.
3. Please keep your blood pressure/ cholesterol with in normal range. Do not smoke at all. Continue with your workout, as you are doing. Keep yourself stress free. Reduce your alcohol intake to 1-2 pegs a day. (e.g. it is not good if one is taking 5 pegs a day, twice a week).
Hope this helps.
Feel free to discuss further.
Sincerely
Sukhvinder
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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