Heart Health Archive

On call

Q. I have atrial fibrillation and currently take warfarin (Coumadin) to prevent a stroke. I haven't had any problems with it, but I wonder if I should switch to one of the newer blood thinners. Are there any advantages?

A. For about 50 years, warfarin was the only choice for people who needed to take an oral anticoagulant (blood thinner). While warfarin is inexpensive, it has its downsides. People who take it must regularly undergo a blood test, called an INR, to ensure they are getting the proper dose. A person's blood should be "thin" enough not to clot easily, but not so thin as to pose a high bleeding risk.

Age, family history, and other risk factors determine if daily aspirin can help prevent a heart attack or stroke.

For many of us, aspirin was the go-to medicine of our youth. Everything from headaches, colds, and general aches and pains were treated with two aspirin and a glass of water.

For decades, aspirin was widely believed to be a safe way to protect healthy adults from heart attacks and strokes. But over the past couple years, new research has questioned this premise and many doctors have already stopped prescribing aspirin for adults at low risk of cardiovascular disease.

In the journals

Need another reason to get your annual flu shot? It could protect you from a fatal heart attack or stroke if you suffer from high blood pressure, according to research presented at a 2019 joint conference of the European Society of Cardiology Congress and the World Congress of Cardiology.

Previous research has found that the inflammation from a flu infection can trigger a heart attack or stroke, and people with high blood pressure are especially at high risk.

Research we're watching

Women experiencing heart failure are less likely than men with the same condition to receive a mechanical heart pump designed to help blood circulate through the body, says a study published in the September issue of the journal Circulation: Heart Failure. The pump, called a left ventricular assist device, or LVAD, is typically used in people who have advanced heart failure. Looking at data from nearly 30,000 hospitalizations in which people received an LVAD device, the researchers found that women made up only 21.9% of those recipients. That number represented a decline from 2004, when 25.8% of LVAD recipients were women. The study's author said the difference might reflect a reliance on outdated statistics that showed women were more likely to die after receiving LVAD devices. This is no longer the case with new versions of the device.

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People who have elevated blood pressure readings in a doctor’s office but normal readings elsewhere are said to have white-coat hypertension. A new study suggests that people with this condition face a greater risk of heart disease than those whose blood pressure is always normal.

Heart failure — this dire-sounding term often brings to mind a heart that has beat its last. Not so. Heart failure means that the heart isn't able to pump enough blood to meet the body's needs. Common effects of heart failure include fatigue, shortness of breath, and swelling in the legs.

Many people are surprised to learn that heart failure is often a manageable condition. Taking medications, balancing exercise and rest, following a low-sodium diet, and being careful about fluid intake can help keep it in check. But heart failure can be unpredictable. After a long stretch of being under control, it can flare up, and even require a hospital stay.

Most people know that too much salt is bad for them and they should try to cut back, but many don’t realize it’s also possible to consume too little salt. It’s not a common problem, but it does happen and it can be harmful.

New recommendations could affect millions of people.

You may remember a time when taking a daily baby aspirin was almost a rite of passage for generally healthy older adults. The idea was that, for people with a low to moderate risk for heart disease, aspirin therapy was a simple and cost-effective way to help prevent a heart attack or stroke.

But taking aspirin increases the risk for bleeding in the stomach and brain (see "How aspirin affects the body").

Ask the doctor

Q. For 25 years, my doctor has recommended low-dose aspirin to reduce my risk of a heart attack. Recently, he told me that new studies indicate that I can stop. What's changed?

A. Millions of people are asking the same question. I'm afraid some of them think that, when doctors change their recommendations, it means we really don't know what we're doing. To the contrary, the recommendation you got 25 years ago was based on sound scientific evidence, and so is the recommendation you received recently.

Ask the doctor

Q. Your article about interval training in the September issue suggests a target heart rate of at least 80% of your maximum heart rate during the high-intensity intervals. But what about people like me who take drugs such as metoprolol, which lowers the heart rate? Should I adjust my target heart rate for exercise?

A. Metoprolol (Lopressor, Toprol) belongs to a class of drugs known as beta blockers. As you mentioned, these drugs reduce your heart rate; they also lower blood pressure. They work by blocking the effects of the hormone epinephrine (also known as adrenaline), causing your heart to beat more slowly and with less force. These drugs are often prescribed for people who have had a heart attack, as well as those with heart failure, atrial fibrillation, or angina.