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Heart Attack

What is Heart Attack?

A coronary attack (heart attack) occurs when the blood flow to a
part of the heart is blocked (often by a blood clot). This happens
because coronary arteries that supply the heart with blood slowly
become thicker and harder from a buildup of fat, cholesterol and
other substances, called plaque.
If the plaque breaks open and a blood clot forms that blocks the
blood flow, a heart attack occurs. Then the heart muscle supplied
by that artery begins to die. Damage increases the longer an artery
stays blocked.
Once that muscle dies, the result is permanent damage. Disability
or death can result, depending on the level of damage.

Role of Aspirin
During a suspected heart attack, aspirin can play a critical lifesaving role if taken as directed by
a doctor. Aspirin reduces the risk of death by up to 23 percent if administered when a heart
attack is suspected and for 30 days thereafter. The use of aspirin as a heart attack first aid could
potentially save 10,000 lives each year.
Aspirin works to help prevent blood clots
Aspirin helps prevent the aggregation of platelets or blood clotting. Platelets release a prostaglandin called
thromboxane. Aspirin's irreversible prostaglandin blocking ability inhibits the biosynthesis of thromboxane and,
consequently, reduces the tendency for blood to clot. This is the reason aspirin should not be used with prescription
drugs for anticoagulation (thinning the blood) unless directed by a doctor.

Risk Factors
Major risk factors have been shown by medical research to significantly increase the risk of heart and cardiovascular events, such as heart
attack or stroke. Some of them can be changed or treated, and some cannot. The more risk factors you have, the greater your risk of heart
attack or stroke. Controlling as many of these risk factors as possible is the best way to keep your heart healthy.
Major risk factors for heart attack that cannot be changed:
Increasing age -- About 85 percent of people who die of coronary heart disease are age 65 or older. At older ages, women who have heart
attacks are twice as likely as men are to die from them within a few weeks.
Male gender -- Men have a greater risk of heart attack than women, and they have attacks earlier in life. Even after menopause, when
women's death rate from heart disease increases, it's not as great as men's.
Heredity (including race) -- Children of parents with heart disease are more likely to develop it themselves. African Americans have more
severe high blood pressure than caucasians, which may increase their risk of heart attack.
Major risk factors for heart attack that can be modified or treated:
You can change or treat these factors to lower your risk by focusing on your lifestyle habits or by taking medicine if needed.
Tobacco smoke -- Smokers' risk of
heart attack is more than twice that of nonsmokers. Cigarette smoking is the biggest
risk factor for sudden cardiac
death: smokers have two to four times the risk of nonsmokers. Smokers who have a
heart attack are more likely to die
and die suddenly (within an hour) than are nonsmokers. Available evidence also
indicates that chronic exposure to
environmental tobacco smoke (secondhand smoke, passive smoking) may increase
the risk of heart attack.
High blood cholesterol levels -- The
risk of heart attack and stroke rises as blood cholesterol levels increase. When other
risk factors (such as high blood
pressure and tobacco smoke) are present, this risk increases even more. A person's
cholesterol level is also affected by age, gender, heredity and diet.
High blood pressure -- High blood pressure increases the heart's workload, causing the heart to enlarge and weaken over time. It also
increases the risk of stroke, heart attack, kidney failure and congestive heart failure. When high blood pressure exists with obesity, smoking,
high blood cholesterol levels or diabetes, the risk of heart attack or stroke increases several times.
Physical inactivity -- Lack of physical activity is a risk factor for heart attack. Regular, moderate-to-vigorous exercise plays a significant role
in preventing heart attack. Even moderate-intensity physical activities are beneficial if done regularly and long term. More vigorous activities
are associated with more benefits. Exercise can help control blood cholesterol, diabetes and obesity as well as help to lower blood pressure
in some people.
Obesity and overweight -- People who have excess body fat are more likely to suffer heart attack or stroke even if they have no other risk
factors. Obesity is unhealthy because excess weight increases the strain on the heart. It's directly linked with heart attacks because it
influences blood pressure, blood cholesterol and triglyceride levels and makes diabetes more likely to develop. If you can lose as little as 10
to 20 pounds, you can help lower your risk.
Diabetes mellitus -- Diabetes seriously increases the risk of suffering heart attack. Even when glucose levels are under control, diabetes
increases the risk of heart attack or stroke. Two-thirds of people with diabetes die of some form of heart or blood vessel disease. If you have
diabetes, it's critically important for you to monitor and control any other risk factors you can.

What other factors contribute to heart attack risk?

Individual response to stress may be a contributing factor. Some scientists have noted a relationship between heart attack risk and stress in
a person's life, their health behaviors and socioeconomic status. These factors may affect established risk factors. For example, people
under stress may overeat, start smoking or smoke more than they otherwise would.

Warning Signs and What to do in Case of Heart Attack

Heart attack is the nation's leading killer, yet many sufferers deny their symptoms and do not take immediate action. Action taken within
the first hours after a heart attack is critical to survival. The average sufferer gets to the hospital almost 5 hours after the onset of
symptoms significantly increasing their chance of dying. Therefore, it is important to be educated about heart attack symptoms and
know when and how to react.
The most common warning signs include:
pain or heavy pressure in chest
pain in shoulders, neck or arms
shortness of breath
React before it's too late
Don't make excuses for heart attack symptoms. Take fast action if you think that you or someone around you is having a heart attack. Never mistake heart
attack symptoms as "indigestion" or feel that you are creating a false alarm acting fast can save lives.
If you experience heart attack symptoms, don't delay -- call 911, and as directed by your doctor, chew or crush and swallow an aspirin followed by a drink of
water, if possible. Taking aspirin immediately at the onset of heart attack symptoms may prevent the formation of additional small blood clots blocking
blood flow through clogged arteries. If that happens, heart muscle damage may be prevented or delayed, buying time to get to the hospital.

What is a Stroke?
Stroke is the third leading cause of death and a major cause of
serious, long-term disability for Americans. Stroke kills over
160,000 Americans each year and on average, someone in the
United States dies of a stroke every 3 minutes. Despite its
seriousness, studies show that less than 40 percent of Americans
can name a single warning sign. Furthermore, many people do not
know that aspirin is the only analgesic proven to reduce the risk of
cardiovascular death, including fatal ischemic stroke, when used
as directed by a doctor.
A stroke (also called a brain attack) is a sudden interruption of
blood flow to the brain, usually caused by blood clots that block
vessels and can result in death of brain cells. A stroke can cause
vision problems, paralysis, speech difficulties or loss of consciousness.

The Facts About Stroke

A continual supply of blood must flow through the brain for it to function properly. Blood supplies energy to this
vital organ and if its flow is hindered as a result of a clogged or ruptured blood vessel, stroke occurs. Following are
facts about stroke and how it impacts stroke survivors and their families each year.
What are the types of stroke?
Ischemic - Caused by clots that form and block blood flow to the brain; accounts for 80 percent of all
strokes. This also includes transient ischemic attacks (TIA) or mini-stroke - A sudden yet temporary
interruption of blood flow to the brain resulting in stroke symptoms that last for several minutes; 36 percent
of TIA suffers will eventually have a stroke.
Hemorrhagic - Occurs when weakened blood vessels in the brain rupture and fill the surrounding area with
blood, which damages brain tissue; accounts for 20 percent of all strokes
What impact does stroke have on the body?
Strokes can cause one or more of the following problems:
Paralysis or muscle weakness
Impaired vision

Role of Aspirin
The FDA has approved the use of aspirin to prevent stroke in men and women who have already had an ischemic stroke or mini-stroke.
Just as aspirin has become standard therapy in reducing the risk of a second heart attack, it can be used under a doctor's direction by
thousands of stroke survivors to decrease the likelihood of a second stroke.
Aspirin helps prevent the aggregation of platelets or blood clotting. Platelets release a prostaglandin called thromboxane. Asprin's
irreversible prostaglandin blocking ability inhibits the biosynthesis of thromboxane and, consequently, reduces the tendency for blood to clot. This is the
reason aspirin should not be used with prescription drugs for anticoagulation (thinning the blood) unless directed by a doctor.
An aspirin regimen may help prevent a second ischemic stroke, but will not prevent hemorrhagic strokes. In fact, aspirin use slightly increases the risk of
hemorrhagic stroke. If you have a history of stroke, make sure you know what kind of stroke you had. Talk to your doctor and make sure aspirin use is right
for you.

Warning Signs and Risk Factors

Stroke Warning Signs
The warning signs for stroke are different than those of a heart attack. Recognizing the warning signs of stroke and getting immediate medical
attention are crucial in helping your chances of recovery. Call your doctor or an ambulance immediately if you experience any of these symptoms:
Sudden numbness or weakness in your face, an arm or a leg, or on one side of your body (The most common warning sign)
Sudden dimness or loss of vision, particularly in one eye
Loss of speech, or difficulty talking or understanding speech
Sudden, severe headache with no apparent cause
Dizziness, unsteadiness, or a sudden fall, especially along with any of the above symptoms
What are the risk factors for stroke, who is at risk, how is risk reduced?
Risk factors
High blood pressure
High cholesterol
Cigarette smoking
Physical inactivity


People at risk
Men and women age 55 and over
Stroke or TIA survivors
Heart and vascular disease sufferers
People with diabetes
Men and women with a family history of stroke
People with sickle cell anemia
Risk Reduction
Don't smoke
Work with a healthcare professional to control blood pressure, cholesterol level and weight
Incorporate physical activity into daily routine
Develop healthy eating habits
For those who have experienced an ischemic stroke or TIA, aspirin has been proven to reduce the risk of another ischemic stroke when
taken as directed by a doctor. Aspirin is not appropriate for everyone, so be sure to talk to your doctor before you begin an aspirin regimen

Aspirin and Ibuprofen Interaction

Ibuprofen Blocks Aspirin's Ability to Protect Against Heart Attacks
A New England Journal of Medicine study* (December 2001) indicates that taking ibuprofen for pain

in combination with an aspirin regimen can interfere with the positive cardioprotective effect of aspirin. This occurs because:

Ibuprofen can bind to the same site on platelets to which aspirin must bind to confer its irreversible antiplatelet effect.

The data show that ibuprofen has a short-lived and reversible antiplatelet effect. If ibuprofen is blocking the enzyme
(COX-1) on the platelet when aspirin is absorbed, then aspirin will be unable to bind irreversibly to the site.
Aspirin is metabolized quickly and is no longer available when the ibuprofen finally leaves the site. Platelets are then
left unprotected and are able to clot once again.

While the study did not evaluate outcome events, the results may be clinically significant because we generate about 10%
new platelets per day; and these same investigators previously showed that only about 10% of functional platelets (i.e., able
to produce thromboxane) are needed to cause clots via this pathway (Reilly and FitzGerald, Blood, 69:180-186, 1987).
The present study showed that uncoated aspirin taken 2 hours before ibuprofen retained aspirins irreversible platelet effect,
while ibuprofen taken 2 hours before aspirin reduced that protective mechanism. The timing of the dose becomes
complicated when different forms of aspirin are used. For example, the absorption of aspirin from an enteric-coated
formulation is delayed for several hours. The key is to ensure that aspirin is absorbed when no other interfering drugs are
present in the blood.
NOTE: Subsequent epidemiological data does not consistently support these findings.
*For more information on reprints please goto www.nejm.org/custserv/

Aspirin and High Blood Pressure

Aspirin and High Blood Pressure
Cardiovascular disease is the leading cause of death among men and women in

the U.S. Each year, more than 500,000 Americans die of heart attacks and more than 150,000 deaths
are caused by strokes. Cardiovascular disease causes more deaths than all cancers combined.
If your blood pressure is 140/90 mmHg or higher, OR a health professional has said your blood pressure
is too high, you may be at an increased risk for a heart attack or stroke. You can reduce your risk of
heart attack and stroke with a healthier lifestyle.
Your doctor can tell you about the benefits of lowering your high blood pressure, quitting smoking, losing
weight, and exercising. Ask your doctor what you can do to reduce high blood pressure and high blood cholesterol.
Your doctor also can tell you whether you should take aspirin while you are taking medication to lower your high blood
pressure to prevent heart attack or stroke.
Your doctor will likely recommend that you lower your high blood pressure before starting an aspirin regimen.

Questions to Ask Your Doctor

Some Questions you should ask include:

What lifestyle changes might be appropriate for me?

What dietary changes might be appropriate for me?
Are there any over-the-counter medications I should avoid?
Is aspirin right for me?

For additional information about communication with your physician, print out the user-friendly Aspirin Advisor, put it in your pocket, and take it
with you on your next doctor's visit.