Heart Attack Archive

In 2011, federal health officials ended an important government-funded clinical trial designed to test whether taking niacin in addition to a cholesterol-lowering statin might do more to lower heart attack and stroke risk than just taking a statin alone. Interim data indicated that the niacin had no benefit and may have been associated with a small, unexplained increase in stroke risk.

Full results of the AIM-HIGH trial, as it was called, were published several months later in The New England Journal of Medicine. Experts continue to fight over the AIM-HIGH results in that ferocious way that experts often do. Some say the results are strong evidence for not adding niacin to statin therapy. Others are adamant that AIM-HIGH missed the mark because of the way it was designed and that it will take the results of a different trial, dubbed THRIVE, to determine if niacin-statin combinations have cardiovascular benefits.

Are you doing everything possible to prevent a heart attack or stroke?

Dear Reader,

Information about health is often accompanied by numbers — how many people have this disease, what's the risk of developing that condition. Then there are more personal numbers, such as your targets for blood pressure and cholesterol. Understanding all those numbers can be confusing, and much of what the Harvard Heart Letter does is help you make sense of them.

Symptomatically silent, it's often the first step toward a stroke or heart attack.

Blood pressure — your doctor routinely checks it because high blood pressure can contribute to strokes, heart attacks, heart failure, and other serious illnesses.

Q. After a heart attack six years ago, I went on Lipitor (atorvastatin) because my doctor said it was proven to reduce the risk of a second heart attack in high-risk people like me. Three years ago, I switched to a generic (simvastatin) to save money. Now that Lipitor is going generic, should I switch back? And can I be assured that the generic version will be as effective as brand-name Lipitor at preventing a second heart attack?

A. The statins are a great class of drugs, and I don't think there is any reason to switch from one statin to another as long as you are reaching your LDL cholesterol goal and are not having side effects.

Medical therapy is better for late treatment.

Imagine this scenario: You've finally gone to the hospital because of chest pain you were having yesterday. After an electrocardiogram and blood test, you're told that sometime in the preceding 24 hours a clot in one of your coronary arteries cut off the blood supply to a section of your heart muscle. You had a heart attack!

So should you get an artery-opening angioplasty?

No. In 2006, the Occluded Artery Trial (OAT) determined that performing angioplasty — an invasive and expensive procedure — delivered no tangible benefit to people who'd had a heart attack more than 24 hours earlier and who no longer had symptoms.

Angioplasty a day after a heart attack not worth it

Deyell M, Buller C, Miller L, Wang T, Dai D, Lamas G, Srinivas V, Hochman J. Impact of National Clinical Guideline Recommendations for Revascularization of Persistently Occluded Infarct-Related Arteries on Clinical Practice in the United States. Archives of Internal Medicine 2011; 171: 1636-1643.

Terkelsen C, Jensen L, Tilsted H, Trautner S, Johnsen S, Vach W, Bøtker H, Thuesen L, Lassen J. Health care system delay and heart failure in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: follow-up of population-based medical registry data. Annals of Internal Medicine 2011;155:361-7.

The brief boost in risk usually doesn't linger.

Artery-clogging atherosclerosis is a slow, silent process that often begins in one's teens or 20s. Some people with atherosclerosis live out their lives completely untouched by it. Some develop chest pain (angina) or other problems when they exercise or are under stress. And some have heart attacks or strokes.

Frequent blood testing after a heart attack can deplete red blood cells.

Anemia — having too few oxygen-carrying red blood cells in circulation — is a blood problem that plagues millions of people. Among anemia's many possible causes are diets poor in iron or folic acid, kidney disease, internal bleeding, and cancer.

Good news for heart attack victims: hospitals across the country have shaved more than 30 minutes off the time it takes to begin artery-opening angioplasty and stent placement, the best treatment for a heart attack in progress.

Hospitals use a measure called door-to-balloon time (named after the balloon used to open an artery) to track how quickly they can get a patient from his or her arrival at the hospital to the start of angioplasty. In 2005, the median door-to-balloon time was 96 minutes. At the end of 2010, it was 64 minutes (Circulation, Aug. 30, 2011). That's a remarkable improvement, prompted by efforts from the American Heart Association, the American College of Cardiology, and other organizations.

People with heart disease should take aspirin; the decision is trickier for those without it.

For survivors of a heart attack or a clot-caused (ischemic) stroke, and for almost everyone else with coronary artery disease, there's an across-the-board recommendation to take an aspirin a day. But what about folks who haven't been diagnosed with heart disease? Can an aspirin a day help them, too?