Medical devices Archive

These drugs are mainstays for preventing heart disease. Are they safe and effective in older people?

Low-dose aspirin and statins are both common, inexpensive drugs that help prevent the two root causes of most heart attacks — blood clots and cholesterol-laden plaque clogging the arteries of the heart. In recent years, a number of studies have helped experts refine their advice as to who should or should not take these medications.

However, evidence-based advice for people in their mid-70s and beyond is a bit harder to come by. Historically, most drug trials have included only a small proportion of people 75 and older, in part because there are fewer people in that age demographic. Also, older people tend to have other chronic health conditions. As such, they may be more prone to drug side effects, making doctors reluctant to enroll them in clinical trials.

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.

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 The study's author said the difference might reflect a reliance on outdated statistics that showed women were more likely to die after receiving LVAD devices.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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Research we're watching

Women at high risk for breast cancer might benefit from taking medication to prevent the disease, says a new recommendation from the U.S. Preventive Services Task Force (USPSTF), a national group of experts. Medications such as tamoxifen (Nolvadex), raloxifene (Evista), and aromatase inhibitors have been shown to help prevent invasive, estrogen receptor-positive breast cancer, but they can cause serious side effects, such as other cancers and blood clots. For some women, the potential benefits of these drugs outweigh those risks. The USPSTF, however, recommends against routine use of these medications for women who are not at high risk for breast cancer, because the potential benefit is much smaller. Women who are over age 35 and are at high risk for breast cancer or who have had previous benign breast lesions (such as atypical ductal or lobular hyperplasia or lobular carcinoma in situ) might want to discuss this recommendation with their doctor. The USPSTF encouraged doctors to weigh the risk of breast cancer against potential drawbacks of the medications and the individual woman's risk for adverse effects.

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Over the past decade, research has revealed that the majority of patients treated for cancer experience difficulties with memory, attention, concentration, and thinking. There are several lifestyle actions that can help improve these symptoms, as well as certain medications.

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.

Known as bradycardia, this heart rhythm disorder can cause fatigue, dizziness, and fainting.

The steady beat of your heart depends on a crescent-shaped cluster of cells in the upper right portion of your heart. Called the sinoatrial or sinus node, it emits a tiny jolt of electrical current that triggers the heart to contract and pump blood throughout the body (see illustration). Because the sinus node determines the heart's pace and rhythm, it is sometimes called the body's natural pacemaker.

Just as your skin, joints, and other parts of your body reveal signs of normal wear and tear as you age, so too can the structures inside your heart. "This age-related degeneration can affect the sinoatrial node and other parts of the heart's conduction system," says Dr. Peter Zimetbaum, director of clinical cardiology at Harvard-affiliated Beth Israel Deaconess Medical Center.

Research we're watching

To manage the painful joint disease known as osteoarthritis, people often take ibuprofen (Advil, Motrin) and naproxen (Aleve, Anaprox). But these and related drugs — known as NSAIDs — may account for the higher rates of heart disease seen in people with osteoarthritis, a new study suggests.

Researchers matched 7,743 people with osteoarthritis with 23,229 healthy people who rarely or never took NSAIDs. People with osteoarthritis had a 42% higher risk of heart failure and a 17% higher risk of coronary artery disease compared with healthy people. After controlling for a range of factors that contribute to heart disease (including high body mass index, high blood pressure, and diabetes), they concluded that 41% of the increased risk of heart disease related to osteoarthritis was due to the use of NSAIDs.

Can you do anything about hand and finger joint pain?

Everyone experiences the occasional painful hands and sore fingers, but when osteoarthritis strikes, it can put a hold on many aspects of your life.

"As osteoarthritis progresses, you may lose some hand mobility, like the ability to grasp and hold objects," says Dr. Robert Shmerling, clinical chief of rheumatology at Harvard-affiliated Beth Israel Deaconess Medical Center and senior faculty editor at Harvard Health Publishing. "Over time, osteoarthritis can make the joints deformed, so it's harder to open and close your hands."