Peripheral artery disease Archive

Ask the doctor

Q. I recently started taking low-dose aspirin, per my doctor's advice. But I heard that for some people, aspirin doesn't help prevent heart attacks. Is this true, and is there any way to find out if I'm one of those people?

A. The phenomenon you're referring to is sometimes called aspirin resistance. However, true aspirin resistance is very uncommon. There are tests for the problem, but I don't recommend them.

The net benefit of these popular supplements is very limited.

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Millions of Americans swallow an amber-colored capsule of fish oil each day, lured by its alleged health benefits. In the supplement aisle of most pharmacies, supermarkets, and big-box stores, the shelves are crowded with different brands of fish oil supplements (see "Fish oil: A brief history"). Many tout benefits for the heart. In fact, the label of one popular brand includes the phrase "May reduce coronary heart disease risk."

But those bold marketing claims haven't caught up with the latest science. Earlier this year, the American Heart Association (AHA) issued an updated advisory about fish oil supplements and their cardiovascular benefits. Their verdict: Fish oil supplements may slightly lower the risk of dying of heart failure or after a recent heart attack. But they do not prevent heart disease. (A separate AHA advisory about fish consumption is slated for release in 2018.)

Closing a gap inside the heart may help prevent a rare type of stroke from recurring.

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Most strokes occur when a clot blocks blood flow to part of the brain. Often, doctors can tell what caused the clot to form. But about a quarter of the time — especially in people younger than 60 — there is no obvious reason. These types of strokes are known as cryptogenic (meaning "of hidden origin").

One possible cause underlying a cryptogenic stroke is an opening in the wall that separates the heart's right and left upper chambers (atria). Known as a patent foramen ovale, or PFO, this flaplike opening is quite common. About one-quarter of all adults have a PFO (see "What is a patent foramen ovale?").

A novel anti-inflammatory drug may discourage repeat heart attacks.

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Inflammation grabbed the attention of researchers a couple of decades ago as a primary culprit in the progression of cardiovascular disease. However, identifying a drug therapy that leverages this link has been more elusive. With the results of the recent Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS), published in the Sept. 21, 2017, issue of The New England Journal of Medicine, it appears that the dots are finally beginning to connect.

"For the first time, we have an anti-inflammatory therapy that can reduce the chance that a person who has already had a heart attack will have a repeat occurrence," says Dr. Peter Libby, a cardiologist at Harvard-affiliated Brigham and Women's Hospital. "This opens up a new field of treatment and offers hope to our patients." He is one of the co-authors of the study, which was led by his colleague and fellow Harvard Medical School professor Dr. Paul Ridker.

Screening tests for lung and breast cancer—chest computed tomography (CT) scans and mammograms—may offer clues about a person’s risk of heart disease.

Your body depends on the mineral potassium for many bodily functions, including keeping control of the electrical balance of your heart, metabolizing carbohydrates, and building muscle.

Low potassium levels can cause muscle weakness and heartbeat irregularities. On the other hand, too much potassium can cause your heart to stop.

It may help prevent a heart attack or stroke, but it comes with the risk of bleeding.

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Maybe you've heard about people who take a low-dose aspirin each day to ward off heart problems. Since aspirin is a medicine you've probably used now and then without a problem, and since it is available without a prescription, you might consider trying a daily low-dose aspirin yourself. Don't do it. Unlike deciding to take a multivitamin, taking a daily aspirin isn't something you should decide to do on your own.

Aspirin therapy is typically prescribed to people who have atherosclerosis of the arteries of the heart or brain, or risk factors for such disease. Just who should take a daily aspirin, how much aspirin, and what type of aspirin are hotly debated issues, with clinical trials under way in search of answers. "Until those results are in, you should talk to your doctor before starting aspirin," says Dr. Deepak Bhatt, a cardiologist and the editor in chief of the Harvard Heart Letter.

Even if you exercise regularly, sitting for long periods during the day is unhealthy for your heart.

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On average, we spend more than half of our waking hours sitting down: working at a computer, watching television, traveling in a car, or doing other sedentary things such as reading or chatting with friends. But long stretches of uninterrupted sitting have a range of undesirable effects that may harm your heart, says Dr. Beth Frates, who directs wellness programming for the Stroke Research and Recovery Institute at Harvard-affiliated Spaulding Rehabilitation Hospital.

"Sedentary behavior affects your body in many different ways, even down to the molecular level," she notes.

Ask the doctor

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Q. I heard my cardiologist say to another doctor that I have a "full metal jacket." What does that mean?

A. Cardiologists use the term "full metal jacket" to refer to a long series of stents in one of the heart's three major arteries. Stents are tiny metal cylinders, often with drug coatings, that help prop open arteries to restore blood flow to the heart. They're placed inside arteries during an angioplasty, in which a doctor snakes a thin, flexible tube (catheter) through the blood vessels to a narrowed section. A deflated balloon at the tip of the catheter then inflates, pushing fatty plaque against the artery wall and expanding the stent.