Stroke

FDA strengthens warning that NSAIDs increase heart attack and stroke risk

Gregory Curfman, MD

Assistant Professor of Medicine

Former Editor-in-Chief, Harvard Health Publishing

Back in 2005, the FDA warned that taking nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen increased the risk of having a heart attack or stroke. Last week it took the unusual step of further strengthening this warning. This was done on the advice of an expert panel that reviewed new information about NSAIDs and their risks. Because NSAIDs are widely used, it’s important to be aware of downsides of taking an NSAID and to take steps to limit the risk. The new warnings point out that heart attack and stroke risk increase even with short-term use, and the risk may begin within a few weeks of starting to take an NSAID. The risk increases with higher doses of NSAIDs taken for longer periods of time. The risk is greatest for people who already have heart disease, though even people without heart disease may be at risk.

Special MRI scan could identify stroke risk in people with atrial fibrillation

Howard LeWine, M.D.

Chief Medical Editor, Harvard Health Publishing

Atrial fibrillation is a heart rhythm disorder that affects millions of people. It can lead to potentially disabling or deadly strokes. Researchers from Johns Hopkins University School of Medicine adding motion-tracking software to standard MRI heart scans of 149 men and women with atrial fibrillation. The scans revealed specific changes in the muscles of the left atrium that increased stroke risk in some of the volunteers. These changes were not associated with age or other risk factors for stroke. This could help many people with this condition to avoid taking warfarin or other clot-preventing medications for life. But it is much too early to include MRI as part of the standard evaluation of people with atrial fibrillation — not to mention that such scans would significantly increase the cost of these evaluations. For now, doctors will continue to use standard tools to help determine stroke risk.

Keeping blood pressure under control reduces risk of second stroke

Howard LeWine, M.D.

Chief Medical Editor, Harvard Health Publishing

For anyone who has had a stroke, working to prevent a second one should be Job No. 1. Keeping blood pressure under control is an important part of that job. A study published yesterday in the journal Stroke shows that good blood pressure control after a stroke cuts the chances of having a repeat stroke by more than half. But the study also brought some bad news: less than one-third of stroke survivors in the study managed to get their blood pressure under control. Measuring blood pressure at home is one way to help control blood pressure—seeing that it is high can help you take steps to bring it down. These include lifestyle changes and medications.

Death of a spouse or partner can lead to heart attack or stroke

The grief of losing a spouse or partner affects not just emotional and mental health, but physical health as well. The surviving spouse or partner often develops health problems in the weeks and months that follow. A study published this week in JAMA Internal Medicine found that individuals who had lost a spouse or partner were more likely to have a heart attack or stroke within the next 30 days. Grief activates the sympathetic nervous system, which is responsible for revving up the body’s fight-or-flight response. That can lead to stress-induced changes in blood pressure, heart rate, and blood clotting. There is also a tendency after such a profound loss for the surviving spouse or partner to disregard his or her own health. It can take several months to a year to work through grief and grieving. If it lasts much longer, and is interfering with daily life—seeing friends, doing once-pleasurable activities—it’s possible that grief has morphed into something more serious, like depression.

Ultra-rapid treatment reduces odds of post-stroke disability

Howard LeWine, M.D.

Chief Medical Editor, Harvard Health Publishing

When it comes to treating stroke, time is brain and every minute counts. That tenet was supported yet again by an international study showing that the sooner clot-busting treatment is begun—preferably within 90 minutes of the onset of stroke symptoms—the greater the chances of surviving a stroke without a disability. This finding makes it even more important to recognize the warning signs of stroke. Think FAST: Face (when the person smiles, does one side droop?), Arms (when the person lifts both arms, does one drift down?), Speech (is the person’s speech slurred or incomplete?), and Time (if one or more stroke signs are present, call 911 right away and get the person to the nearest hospital with an emergency department—better yet, to one with a stroke center).