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M. P. Ravindra Nathan

The latest statistics regarding the “leading causes of death in USA” are just in. For the year ending 2005, the figures are:

Total Deaths: 2,447,910 Heart disease: 649,910

Cancer: 559,300

Stroke: 143,497

So, heart disease (mainly coronary heart disease or CHD) still remains the No. 1 cause of death, a position it has held for the past many years, followed by cancer and stroke. And there is one simple medicine that can go a long way in protecting you from heart attacks and strokes.

Just take an aspirin a day.

Aspirin is cheap, easy to get, relieves pain and inflammation in the body and helps to prevent heart attacks and clot-related strokes – both labeled as ‘vascular diseases.’ It may prevent cancer too! The old adage “An ounce of prevention is better than a pound of cure,” is still true, especially considering the mortality, morbidity and the enormous expenses these diseases entail.

According to Eduardo Sanchez, chair, National Commission on Prevention Priorities (NCPP), “The sad fact is that high-value preventive care (such as aspirin usage) is widely underused and as a result, there are millions of people whose lives are shortened or who are unnecessarily sick, are less productive than they would be otherwise, and who incur hefty medical expenses. Closing the gaps in the use of just five preventive services would save 100,000 lives annually in the USA.” Asian Americans have been cited to have the lowest utilization of any group for aspirin use.

Who may benefit from aspirin therapy? People with CHD, those who already had a heart attack or anyone showing ‘atherosclerosis’ anywhere in the body, including the brain or legs are prime candidates for aspirin protection. Same is true for those who have angina or have undergone coronary bypass surgery. In fact, people with any risk factors for CHD/ heart attacks should be considered. Such risk factors include “high blood pressure, diabetes, tobacco smoking, high cholesterol levels, family history and genetic factors, obesity, sedentary lifestyle, men over the age of 40 and post menopausal women.” In addition, people who have had a mini stroke (TIA) or ischemic stroke also would benefit. Even asymptomatic atherosclerosis poses a substantial risk and aspirin has the potential to prevent these catastrophic events.

“Can long-term use of aspirin keep mortality in women at bay?” was the focus of the recently published ‘Nurses’ Health Study,’ from Harvard Medical School. This 30-year-old data collection effort enrolled more than 120,000 registered nurses who provided researchers with detailed information on their aspirin use through surveys submitted every two years. After careful analysis, the authors concluded, "Use of aspirin for one to five years was associated with significant reductions in cardiovascular disease mortality. In addition, a significant reduction in risk of cancer deaths was also observed although only after 10 years of aspirin use.”

The benefit associated with aspirin was seen with low and moderate doses (81-162 mg) and was significantly greater in older participants and those with more cardiac risk factors. Bayer and Glaxo Smith Kline market aspirin in three strengths: 81 mg (baby), 325 mg (adult) and 500 mg (extra strength). If you do have a history of strokes or heart attacks, have drug-eluting stents, artificial valves, etc., your doctor may recommend not only adult strength aspirin, but a second drug such as clopidogrel for complete vascular protection. So do follow your doctors’ orders.

Does aspirin therapy differ between men and women? This debate has been going on for some time. Early studies on daily aspirin therapy were done mostly in men. More recent studies have focused on the effects of aspirin in women, finding that its effects indeed differ between the sexes. Aspirin appears to be more effective in preventing a first stroke in women than in men, but is more effective in preventing a first heart attack in men than in women. Although there is an apparent dichotomy of benefit based on sex, the most recent guidelines recommend aspirin for the prevention of all cardiovascular diseases in men. And in high-risk individuals regardless of sex, I think we should use aspirin for overall vascular protection.

How does aspirin work? Aspirin inhibits the sticky quality of certain blood cells called platelets. It is the platelet adhesiveness or the ‘clumping’ which leads to clots, the fundamental process in heart attacks and to a great extent, in strokes as well. Its blood- thinning ability is so effective, it is now a standard recommendation for people over 40 who are at high risk or cardiovascular disease.

Any side effects? Yes, aspirin has to be used carefully by those who have stomach problems such as ulcers, heart burns, gastrointestinal bleeding, etc. Buffered or coated aspirin are always preferred but some simply cannot tolerate aspirin in any form. The risk of bleeding, however, is nearly equal in both sexes and certainly more if you are a regular alcohol user. Hence, the U.S. Food and Drug Administration warns: “People who regularly take aspirin shouldn't drink alcohol. Patients who have heart disease should stop drinking alcohol and keep taking aspirin if their doctor prescribed aspirin as part of the treatment plan for their heart condition. In any case, do not stop aspirin without talking to your doctor first.”

The newly released update from NCPP indicates that if aspirin use increases from its current utilization rate of 40 percent in high risk individuals to a rate of 90 percent, it could save 5,000 more lives per year! So, ‘Prevent the Event’ should be your mantra. Imagine the power of this magic pill!

(More about preventive care to follow)

Cardiologist Dr. M. P. Ravindra Nathan, director of Hernando Heart Clinic in Brooksville, lives in Brooksville.

Payal Patel

In this article, I would like to stress the importance of prevention of obesity since it is much easier than treating it. Prevention is the key to protection against many diseases that go hand in hand with obesity such as hypertension, diabetes, etc.

Prevention should begin from early stages of life as a newborn. Breast feeding is essential along with delay in introduction of solid foods at six months of life instead of four months. The American Association of Pediatrics (AAP) recommends that breastfeeding be continued for one year or longer for substantial benefits along with availing weight gain. Introducing the right foods also is important such as introducing vegetables before fruits as a way of introducing taste development to less sugar, and less calorie-rich foods. Avoiding processed and junk food through toddler hood also helps develop healthy eating habits that will last lifelong. In this day and age, processed foods as well as food coloring are leading cause of increased attraction to such foods, which are related to obesity, diabetes, Attention Deficit Hyperactivity Disorder (ADHD), etc, in kids.

As parents, we are responsible for making choices for our kids. Offering them a banana as a snack, instead of a cookie is a matter of choice that we should make. This does bring changing our own habits into account. As I had mentioned in Part I of my article, don’t expect your child to eat a salad if you are eating French fries. Moderation is the key. None of us can completely eliminate high calorie, processed food completely, but having them occasionally is the alright. It is not easy to ask a child to give up candy when his friends are having the same, but limiting it to no more than one is important.

Children are often picky eaters in their toddler years, but making healthy food part of the household has to be a repeated effort. Some foods have to be introduced to kids about 10-15 times before they develop a taste for it. It can be frustrating but knowing you are doing the right thing should be a reward in itself. Involving the kids in food choices from early on also is essential. Giving them a choice between a banana and an apple is correct, but giving them a choice between banana and a cookie will result in failure to comply. Involving the kids via taking them for grocery shopping and asking them to help pick the right foods will give them a sense of control and understanding about a healthy lifestyle.

When preparing a meal, asking them to get a tomato from the refrigerator or pretend play in making roti also is helpful. Eating together as a family stresses the importance of everyone eating the same type of food in the family as well as cultivates positive thinking. Eating at home vs. outside also gives control over food choices and eliminates the possibility of having calorie-rich foods. When eating outside, making choices such as grilled foods vs. fried, and a glass of water vs. soda stresses healthy eating habits inside and outside the home. Food should not be used as a reward. For example, putting his shoes in the right place should not warrant the child to have candy but instead offering a star sticker or a penny for his piggy bank is okay.

Exercise also is important for the family starting from early ages. Children should play for one hour a day or do an activity as a family such as walking after dinner, or bike riding, or just playing catch. Parents should stress the importance of exercise by discussing with their children why they chose to join a gym or run on a treadmill to be role models for their childrens' future. Limiting TV watching or videogames to no more than one hour a day also decreases chances of inactivity.

Overall, Prevention plays a huge role in a family. Children should never be punished for making the wrong choices, because they are influenced by myriad of family and friends. Instead, parents need to be patient, and build self-esteem in a positive fashion via explanation of why right choices such as healthy food and exercise are important. Children may not get it completely, but they will learn from their parents and value their choices eventually. In my next article, with the help of a board-certified dietician and a close friend Bhavi Patel, I will talk in depth about detailed food choices that will benefit children as well as adults.

Happy holidays and best wishes for the New Year.

Payal Patel, a board-certified pediatrician, is at Sunshine Pediatrics, 18928 N. Dale Mabry Highway, Suite 102, Lutz, FL 33548. She also can be reached at (813) 948-2679.

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