Aspirin: Is it Good for You and Your Heart?

Eighty billion aspirin tablets are taken every year to cure pain, inflammation and fevers and even for its cardioprotective effects.

But is aspirin right for you? The answer, say doctors, lies in measuring your health with a risk-benefit ratio.

Aspirin’s values and potential hazards come from the same source: Its ability to prevent the cells in the blood from clotting. The benefit to taking aspirin therapy is to prevent heart attack and ischemic (a blood clot) stroke, but it is not recommended to everybody because it increases the risk for serious bleeding in the gastrointestinal tract and brain (hemorrhagic stroke).

Interventional cardiologist Nabi Dib, M.D., from Arizona Heart Institute in Phoenix, explains the net benefit of aspirin increases with increasing risk for a heart attack or stroke including age, gender, high cholesterol, diabetes, strong family history, hypertension, and smoking.

The highest risk factor for a heart attack or ischemic stroke is having already had one. In general, if you belong to this group the Food and Drug Administration and the American Heart Association, among others, say the benefits of a daily aspirin will far outweigh the risks. Also in this group, known as secondary prevention, are patients with known coronary artery disease, atherosclerosis, cerebral vascular disease, or peripheral vascular disease.

On the other hand, if you are a healthy 30-year-old with no major risk factors, the risks will far outweigh the benefits.

But then there is a large group of people who fall into the middle category whose prescription is not so clear. Some doctors like Dr. Dib draw the line for aspirin therapy at people who have two or more risk factors for coronary artery disease.

It is also important to note the risk factors are not dichotomous, says cardiologist John Alexander, M.D., from Duke University Medical Center in Durham, N.C. For example, a patient may have only one risk factor, but if it is very severe high cholesterol or family history, it may call for aspirin therapy.

Dosage:

The largest study on aspirin therapy was performed with 325 milligrams of aspirin, or one adult aspirin tablet. In deciding which dose to take, cardiologist Paul Hirsh, M.D., from St. Luke’s Hospitals in Cincinnati, says, “If you want to go purely on the largest data then you probably ought to take the 325-milligram tablet.”

However, these doctors agree that taking a baby aspirin tablet, 81 milligrams, seems to be sufficient, which has been proven in smaller studies. Interestingly, Dr. Alexander says, the 325-milligram dose was used when aspirin was first invented over 100 years ago because that was the size that was easiest to combine with starch to form the pill.

Dr. Hirsh says some of his patients on aspirin therapy complain they are bruising too easily and wonder if that is a sign they should be taking a smaller dose. “The problem with that approach is that is the dose that is effective. We’re thinning the blood so you don’t get a spontaneous blood clot forming in a coronary artery. So, if you cut the dose so your blood isn’t so thin then you may be at risk for having that blood clot.” Dr. Alexander adds that aspirin itself won’t cause bruises unless there is also a defect in the wall of the blood vessel. Aspirin doesn’t cause bleeding, it just prevents it from stopping as easily.

The only time when a 325-milligram dose is always recommended immediately is when a patient is having a heart attack. Dr. Alexander explains this dose is to err on the side of precaution, and any risk of a one-time dose of 325 milligrams of aspirin is negligible.

Drug Interaction:

The medical profession agrees aspirin is safe to take with most other drugs. Recent research, contrary to what was previously believed, has shown that aspirin does not affect how the blood pressure medication ACE inhibitors work.

However, it has been suggested that aspirin may interact negatively with some supplements such as vitamin E and omega-3 fatty acids in fish oils. Aspirin has yet to have large studies completed on its interaction with these. In the meantime, Dr. Hirsh recommends you do one or the other as therapy, and the one that is proven is aspirin.

In general, it is recommended to avoid taking non-steroidal anti-inflammatory drugs like Motrin or Advil with a daily aspirin. NSAIDs have the same effect on platelets and you may be more prone to the consequence of bleeding. However, people with arthritis, among others, often find themselves needing to take both NSAIDs and aspirin, and Dr. Hirsh says many of them do it without difficulty. This is an example of where your doctor can advise you best.

In their advisory pamphlet, the Food and Drug Administration says the chance of side effects increases with each new product you use, including over-the-counter medications, prescriptions, and vitamins and herbals. Additionally, the FDA warns against aspirin use with alcohol and other products that contain aspirin like cough, cold or sinus drugs.

Doctors say you cannot take aspirin for too long, but look out for stomach upset, black stool, anemia, and high blood pressure to recognize any bleeding caused by aspirin.

Aspirin Resistance:

Doctors and researchers are now trying to define aspirin resistance. “On biochemical tests it looks like there is variability, not surprisingly, not all people are alike, in the way people respond to aspirin. That is probably true with all drugs. We know a lot, and yet, we have so much to learn about the best way to tailor aspirin therapy,” Dr. Alexander says.

The whole issue of aspirin resistance came about by studying blood work and observing different reactions of people on aspirin therapy. There is no consensus on exactly what aspirin resistance looks like, how best to test for it, or how to treat it.

“For the present, aspirin resistance shouldn’t change the way we do things. We have approaches that are tried and true with the doses of aspirin we’re using across large populations, and that’s what we should all stick to until the issue of aspirin resistance has been further worked out,” Dr. Hirsh advises. Experts agree this may be a larger component of aspirin therapy in the future.

The Future of Aspirin Therapy:

In 2003, researchers publishing in the Archives of Internal Medicine analyzed five studies conducted on aspirin primary and secondary prevention. Among the 55,580 in the five trials, aspirin was associated with a statistically significant 32-percent reduction in the risk of a first heart attack and a significant 15-percent reduction in the risk of all important vascular events. In terms of the risk for hemorrhagic stroke, the five trials suggest an increased risk of one to two per 1,000 patients, which is the same risk found in secondary prevention.

Even with this proof of its success, the study authors say there is underutilization and mismedication with acetaminophen or NSAIDs instead of aspirin. They conclude the more widespread and appropriate use of aspirin would prevent more than 150,000 cardiovascular events in primary prevention.

But before you run out and get an economy-sized bottle of aspirin, the U.S. Preventive Services Task Force recommends you discuss with your doctor the potential benefits and drawbacks of taking aspirin before you start to take it.

And in the future, you might even be prescribed aspirin to prevent some cancers, Alzheimer’s disease and preeclampsia.

This article was reported by Ivanhoe.com, who offers Medical Alerts by e-mail every day of the week. To subscribe, go to: http://www.ivanhoe.com/newsalert/.

Fat soluble vitamins – Vitamin A

Vitamin A refers to any compound or mixture of compounds having vitamin A activity. In animals, vitamin A exists largely in the preformed state as retinol or as one of its related compounds: 3-dehydro-retinol, retinal, retinyl ester or retinoic acid. In plants, vitamin A occurs in the precursor or provitamin forms as carotenoids which may be converted into vitamin A. Vitamin A cannot be synthesized de novo by plants or animals and carotenoids are the only source of vitamin A for the entire animal kingdom.

Carotenoids are a class of closely related natural pigments synthesized by plants. Their main function is to absorb light during photosynthesis and provide protect5ion against photosensitization. Over 600 different carotenoids have been identified and approximately 40 of these occur in common food sources. Beta-carotene, alpha-carotene, lutein, alpha-cryptoxanthin and lycopene are the most common carotenoids found in human plasma. Some of these carotenoids, such as beta-carotene, alpha-carotene, and alpha-cryptoxanthin, are metabolized in the small intestine and function as precursors of vitamin A. However, other carotenoids, such as lycopene and lutein, are devoid of provitamin A activity. Carotenoids are also potent antioxidants and important physiological modulators. In recent studies, lycopene has been suggested to have potential anticarcinogenic properties.

Retinol is high molecular weight alcohol attached to a beta-ionone ring. The beta-ionone ring is essential for vitamin A activity. Retinol is a pale, viscous, fat soluble compound which is fairly heat stable but easily destroyed by oxidation and ultraviolet light. Beta-carotene is a symmetrical molecule consisting of two beta-ionone rings conjugated by a double bond in the center. Theoretically, hydrolysis of beta-carotene in the gut should yield two molecules of retinol. However, because of physiologic inefficiency in conversion of beta-carotene to retinol, the overall utilization of dietary beta-carotene as vitamin A from food is taken as one-sixth that of retinol. The efficiency of utilization of the other provitmain A carotenoids is about half that of beta-carotene.

Sources

The average North American diet provides about half of its vitamin A activity as carotenes from plant sources. Beta-carotene is the most significant carotenoid in the diet; gamma-and alpha-carotene and cryptoxanthine are also present in the diet. Sources of the provitmain A carotenoids include dark green leafy vegetables (chlorophyll masks the yellow carotene color), deep yellow vegetables, tomatoes and deep yellow fruit.

The remainder of dietary vitamin A is obtained from preformed vitamin A from animal sources. Sources of preformed vitamin A include liver, fish liver oil extracts, egg yolks, enriched milk products such as margarine and skim milk and evaporated milk. Some animal products contain both preformed vitamin A and provitamin A; the latter being obtained from the animal’s diet.

Absorption and Storage

Free retinol obtained from the diet or hydrolyzed from retinyl esters in the gut is absorbed into the intestinal mucosal cells, re-esterified and incorporated into chylomicrons, which ultimately enter the circulation. Chylomicron remnants containing retinyl esters are taken up by the liver. Conversion of the ingested carotene to vitamin A takes place primarily in the cells in the intestinal mucosa but also occurs in the liver and possibly the kidney.

Absorption of vitamin A and the carotenoids requires the presence of bile in the intestinal tract and other conditions favorable for fat absorption. Retinoic acid, however, is absorbed directly into the intestinal mucosa and released into the portal circulation complexed with albumin.

Storage of vitamin A occurs primarily in the liver as retinyl ester. When needed, retinol is mobilized from the liver and transported in the circulation to tissues complexed with retinol binding protein (RBP).

Function

Vitamin A plays an important role in normal vision. The photoreceptors of the eye in the retina, which are sensitive to dim light, are the rods that contain 11-cis retinal that combines with the protein opsin to form rhodopsin in the dark. Rhodopsin when bleached by light is converted to all trans retinal and opsin. Conversion of the trans 11-cis retinal completes the cycle. However, when insufficient retinal is available to regenerate rhodopsin, the conversion is incomplete and night blindness (inability to see in dim light) results.

Retinal is also involved in daytime vision as a component of iodopsin. This pigment, contained in the cones of the retina, is sensitive to bright light.

Vitamin A is essential for the integrity and normal growth of epithelial cells. It is also involved in cell differentiation. In the presence of sufficient vitamin A, mucus secreting goblet cells are formed form epithelial basal cells. When there is a lack of vitamin A, the basal cells keratinize becoming hard, dry and irregular in shape.

Vitamin A is required for proper growth and development of bones and teeth. It is also necessary for normal reproduction in animals. Vitamin A is important for the maintenance of membrane integrity and functions of membranes such as those in the skin, respiratory and genitor-urinary tract.

Retinoic acid support normal growth but cannot replace retinol and retinal for night vision.

Deficiency

Vitamin A deficiency is one of the most prevalent forms of malnutrition in the world. Pregnant women, infants and young children are most susceptible.

Primary vitamin A deficiency is due to inadequate intakes of vitamin A or its precursors, the carotenoids. Causes of secondary vitamin A deficiency include malabsorption of fat and the fat-soluble vitamins, failure to convert dietary carotene to preformed vitamin A and depletion of body reserves. Parasitic infections associated with fever and systemic acute phase response also cause secondary vitamin A deficiency. This is probably induced by inflammatory cytokine-related mechanisms which include decrease in the hepatic secretion of retinol-RBP complex, the loss of the complex to the extravascular space or an increased loss in the urine.

The basic pathology of vitamin A deficiency is hyperkeratinization of skin and keratinizing metaplasia of the lining of the respiratory, gastrointestinal and genitourinary tracts and the endocrine, salivary, sebaceous and lacrimal glands. Vitamin A deficiency is associated with increased childhood morbidity and mortality. This is due to an increased risk of infectious diseases particularly in developing countries. Vitamin A supplements can help to achieve a rapid reduction in early childhood mortality and a lower level of childhood mortality can be sustained as long as adequate vitamin A supplementation in maintained.

The first symptoms of vitamin A deficiency are night blindness and drying of the conjunctiva of the eye. Bitot’s spots may be present in the cornea of the eye. With continued vitamin A deficiency, progressive damage to the eye results from drying of the cornea and irreversible corneal damage resulting in xerophthalmia, keratomalacia, and blindness. In children, retarded growth may occur as a result of vitamin A deficiency.

Toxicity

Excessive ingestion of carotenoids, while not toxic to man, results in carotenemia and yellow discoloration of the skin. In large doses preformed vitamin A is toxic to man. Chronic toxicity of vitamin A produces variable symptoms. These may include: anorexia, nausea, vomiting, abdominal pain, dry skin, rashes, headaches, loss of hair, abnormal skin pigmentation, increased fragility and pain in the long bones, menstrual irregularities and enlargement of the liver and spleen.

Due to the danger of chronic toxicity, regular consumption of supplemental doses of vitamin A above 3000 RE (10,000 IU) for children or 7500 RE (25,000 IU) for adults is contraindicated.

Health Benefits

Low intakes of vitamin A and carotene are associated with an increased risk of developing certain cancers, such as breast cancer. However, the role of vitamin A in lung cancer is still unclear. The belief that vitamin A reduces cancer risk is based on the following observations: (1) the requirement of vitamin A for the maintenance of epithelial tissues, a common location where many cancers are located, (2) tumor surveillance by the immune system is dependent on adequate levels of vitamin A and (3) gene expression may be directly influenced by vitamin A and retinoids.

Biologically B-carotene acts as an antioxidant that may have a protective effect against free-radical damage of cellular membranes. For this reason there is much interest in increasing its intake. Ingestion of a large amount of carotenoids is nontoxic but may result in a benign condition characterized by yellow pigmentation of the skin.

Calming the Dragon

Though nobody likes to admit it, everyone has dragon breath from time to time. Bad breath is just an unpleasant fact of life. There are several reasons your breath may be a little sour:

Decrease in saliva. Your body doesn’t produce as much saliva while you’re sleeping, and that’s why many of us wake up to morning breath. Certain medicines also can cause a decrease in saliva.

Strong foods. Garlic, onions, and many other foods can lead to bad breath.

Health condition. Sinus infections, diabetes, acid-reflux, and other conditions can be the cause.

You can control bad breath in many ways:

Brush your teeth, tongue, gums, and the roof of your mouth at least twice daily

Gargle with water or medicated mouthwash

Eat plenty of fruits and vegetables

Visit your dentist regularly

Chew on sugar-free gum or use dissolving breath strips

Eat at regular intervals (skipping meals can decrease saliva).

Chocotionary


Bitter Chocolate

Also known as unsweetened chocolate, although it often contains a small amount of sweetening. It is the chocolate best suited to baking and cooking and is valued by chocolate connoisseurs as its high cocoa solid percentage means a purer and better quality of chocolate.

Cacao Beans

The beans from which chocolate is derived.

Cacao Tree

The fruit of the cacao tree are large pods that contain 30 to 40 beans. This evergreen tree was first discovered in South America.

Chocoholic

A choccy addict – a title most of us can lay claim to!

Chocolate Liqueur

The cold alcoholic version of a hot chocolate drink. Does it get any better?

Chocolatier

The French term for the best sort of people – those who make and sell chocolate.

Cocoa Butter

The yellow-white vegetable fat that comes from the cacao bean. It is removed from chocolate liquid during a refining process at high pressure. As well as being a chocolate product it is also used in cosmetics and moisturizers and is supposed to be great for reducing stretch marks caused by pregnancy.
Cocoa Powder

What remains when cocoa butter is removed from chocolate liquid, cocoa powder is what is used in making a hot drink of the same time.

Conching

The process that turns raw chocolate into the smooth stuff we adore. The chocolate is heated and rolled by granite conch-shaped rollers – hence the name.

Couveture Chocolate

A chocolate containing extra cocoa butter for pouring and dipping purposes. Also known as coating chocolate as it is primarily used by luxury chocolatiers to form a very thin shell of chocolate for truffles.

Dark Chocolate

Made by mixing chocolate liquid with varying amounts of sweetening and cocoa butter.

Drinking Chocolate

Unlike the cocoa drink, this should be made with real, solid chocolate mixed with sugar, milk and cream. It is extremely rich and thick.

Fondants or Creams

Sugar-based centers for chocolate that can be flavored.

Milk Chocolate

Milk or cream is added to a mixture of chocolate liquid, cocoa butter, vanilla and sweetening.

Praline

Made with finely ground nuts and chocolate or caramel. A common filling in Belgian chocolates.

Truffles

A fluffy chocolate, cream and butter mixture, these sweets were named after the expensive French mushroom that they were thought to resemble.

White Chocoalte

Contains no cocoa powder and so is not considered a “true” chocolate by choco-snobs. A combination of vanilla, milk solids, cocoa butter and sugar, white chocolate is made with vegetable fat instead of cocao butter.

Chocolate is the most popular token in affairs of the heart, beating both flowers and perfume. It has become a traditional part of Western courtship rituals.

Fact: a romantic meal just isn’t complete without a rich chocolate dessert.

Italian lovers exchange “baci” or “kisses”, which are wrapped chocolates that contain a romantic message on the inside of the wrapper.

Chocolate is not only thought of as a romantic pleasure but a sensual and sexual one too. A favorite image of the early movies was the blonde, beautiful leading lady in a luxurious bed, sensuously chomping her way through a box of chocs. Sex has been used to sell chocolate for years – the idea of melted chocolate smeared on a naked body and licked off by a lover’s tongue is the hidden undertone of most chocolate adverts.

Chocolate has been considered an aphrodisiac for centuries. The Aztecs believed that chocolate invigorated men and released women from their inhibitions. The Aztec emperor, Montezuma, certainly believed in these properties of chocolate. With a sizeable harem to entertain, he is reputed to have needed up to 50 goblets of chocolate a day to keep his passion at its peak. Ding-dong!

Casanova would drink chocolate instead of champagne to induce that loving feeling. He also gave it to those he desired as a means of having his wicked way with them.

In the seventeenth century chocolate was very commonly employed as an aphrodisiac within the French Court. Art and literature of the period contains strong erotic themes supposedly inspired by chocolate.

Top Chocolate Tips

• If chocolate starts to melt in your hands then you are eating it too slowly.
• Chocolate-covered raisins count as fruit. Eat as many as you like.
The problem: How to prevent your chocolate melting in a journey home from the super market on a hot day in a hot car? The solution: Eat it all in the car park.
Dieters: Eat a chocolate bar before each meal. This will take the edge off your hunger and you’ll eat less.
• A box of chocolates will provide your calorie intake for the day in one neat package.
• If you can’t eat all your chocolate then it is possible to store it in the freezer … but if you can’t eat all your chocolate, what’s wrong with you?
• If you are trying to lose weight, store your chocolate on top of the fridge – calories are afraid of heights and will jump out of the chocolate to save themselves.
• A balanced diet consists of equal amounts of dark and white chocolate.
• There are many preservatives in chocolate – they make you look younger.
Remember: Money talks. Chocolate sings.

Put “eat chocolate” at the top of your list of things to do for the day. That way, at least you’ll get one thing done.

Journal Equations

Success in your walking routine will literally come one step at a time. But you don’t have to embark on each trek blindly. Walking journals not only help track progress by logging measurements like time and distance, they also offer insight into factors that are harder to quantify — such as your mood, physical condition, or uncontrollable variables you encounter on a given day.

Detail your daily experience with both concrete and intangible data so you can assess where you’ve been, where you are… and where you want to be.

Monitor how far you walk each day and how long it takes. Make sure, however, to note what affects your outcome — like road construction or traffic that detoured your route or slowed your pace — or the weather (was it unusually warm or cold that day? Did it rain on your parade?). By monitoring seemingly trivial elements you can better assess your overall improvement.

Record how you feel, and what you’re thinking. Perhaps you had a rough day, or you’re hungry, tired, or sore. Maybe you had a particularly good day that added bounce to your step. Attitudes often bow to the influence of experience, so acknowledge both the emotional and physical fuses that light your mood… then accommodate or adjust.