(Thread from Diabetes) #: 763127 S2/News and Newcomers (CIS:DIABETES) 23-Oct-97 03:24:13 Sb: Aspirin Use Urged Fm: SYSOP-Paula DuBourdieu 73021,567 To: all Replies: 1 TID: 108266 Par: 0 Chd: 763132 Sib: 0 The American Diabetes Association issued a press release on Oct. 20 recommending the use of aspirin for the prevention of heart attacks by diabetics who are at high risk for cardiovascular events. Up to 55 percent of all deaths of people with diabetes are attributed to cardiovascular disease. ADA President, Mayer Davidson MD, is quoted as saying that ``Statements on aspirin therapy have traditionally downplayed its importance for healthy individuals or emphasized its importance for people at risk for a second heart attack. That left numerous questions as to how effective aspirin therapy would be for people with diabetes. These new recommendations close that gap, making aspirin an important preventative for people with diabetes who are at an increased risk for heart disease solely because of their diabetes.'' The ADA press release recommends the use of aspirin for prevention of a first heart attack for both men and women with either Type 1 or Type 2 diabetes who are at high risk. It states that risk factors may include the following: - A family history of coronary heart disease - Cigarette smoking - Hypertension - Obesity, defined as >120% of desirable weight or BMI >28 in women and over >27 in men. - Albuminuria (protein in urine) - High lipid levels (cholesterol over 200 mg/dl, LDL cholesterol over 130 mg/dl, HDL cholesterol under 40 mg/dl; triglycerides over 250 mg/dl) It also recommends aspirin as a secondary prevention therapy for diabetics with evidence of large vessel disease. This would include diabetics who have a history of: - myocardial infarction (MI) /Heart attack - vascular bypass procedure - stroke or transcient ischemic attack (TIA) - peripheral vascular disease - claudication - angina It recommends that diabetics with the following conditions should NOT be considered for aspirin therapy: - diabetics under age 30 without any of the cardiovascular risk factors mentioned above - diabetics with aspirin allergy, bleeding tendency, anticoagulant therapy, recent gastrointestinal bleeding or clinically active liver disease. Past president of the ADA, John Colwell, MD, PhD, wrote the position statement and noted, ``People with Type 2 diabetes need to know that they're at great risk for cardiovascular disease, and that they should take appropriate steps to avoid succumbing to a heart attack. This position statement tells those patients that there's an additional, and very inexpensive, tool to combat this serious complication.'' The press release noted that "for primary and secondary prevention, the dose of enteric-coated aspirin recommended can be as minimal as a baby aspirin (81 mg) to a regular, adult aspirin (325 mg) per day." The position statement is based on results of the U.S. Physician's Health Study, "a double-blind study of male physicians. A subgroup analysis of physicians with diabetes showed that only 4 percent of those undergoing aspirin therapy had a myocardial infarction compared to over 10 percent in the placebo group." It is also based on results of the Anti- Platelet Triallists (APT) and the Early Treatment Diabetic Retinopathy Study (ETDRS). "In the APT, both subjects with and without diabetes were able to reduce their risk of a cardiovascular event by 25 percent through aspirin therapy. The ETDRS, consisting of 3,711 subjects, supported this finding as type 1 and type 2 men and women, 48 percent of whom had a past history of heart disease, were shown to dramatically reduce their chances of a MI after five years." For more information, see the November 1997 issue of Diabetes Care and, of course, talk with your doctor. #: 763132 S2/News and Newcomers (CIS:DIABETES) 23-Oct-97 05:49:22 Sb: Aspirin Use Urged Fm: SYSOP-James Day 102212,3071 To: SYSOP-Paula DuBourdieu 73021,567 Replies: 0 TID: 108266 Par: 763127 Chd: 0 Sib: 0 That ties in nicely with another recent recommendation, to immediately take an aspirin if you experience chest pains, as a way of reducing the risk of those pains becoming a more major incident. James #: 763388 S2/News and Newcomers (CIS:DIABETES) 24-Oct-97 03:27:12 Sb: Aspirin Use Urged Fm: WIZOP-Dave Groves 76703,4223 To: SYSOP-Paula DuBourdieu 73021,567 (X) Replies: 1 TID: 108266 Par: 763127 Chd: 763430 Sib: 0 Funny with Bayer a major diabusiness participant they should recommend aspirin and not follow Harvard's recommendations for alcohol. #: 763430 S2/News and Newcomers (CIS:DIABETES) 24-Oct-97 05:50:29 Sb: Aspirin Use Urged Fm: SYSOP-Paula DuBourdieu 73021,567 To: WIZOP-Dave Groves 76703,4223 Replies: 0 TID: 108266 Par: 763388 Chd: 0 Sib: 0 I've probably mentioned this before but it is kind of interesting to ponder on the reasons for the efficacy of aspirin if the bacteria theory of atherosclerosis is right. I was quite surprised to see Newsweek and others mentioning this theory at last this summer. #: 763651 S2/News and Newcomers (CIS:DIABETES) 24-Oct-97 21:59:17 Sb: Aspirin Use Urged Fm: WIZOP-Dave Groves 76703,4223 To: SYSOP-Paula DuBourdieu 73021,567 Replies: 0 TID: 108266 Par: 763430 Chd: 0 Sib: 0 Perhaps aspirin and alcohol both have mild anti-bacterial properties or are able to prevent the bacteria from forming plaque sites? #: 763840 S2/News and Newcomers (CIS:DIABETES) 25-Oct-97 17:29:02 Sb: Aspirin Use Urged Fm: Mary Whitmore 73364,2375 To: SYSOP-Paula DuBourdieu 73021,567 Replies: 0 TID: 108266 Par: 763430 Chd: 0 Sib: 0 >> kind of interesting to ponder on the reasons for the efficacy of aspirin if the bacteria theory of atherosclerosis is right. << Hi Paula, I think the efficacy of aspirin is more in its anti-clotting action than in any reduction in atherosclerosis, per se. The roughening and occlusion caused by atherosclerosis often causes clotting at the sight which further occludes the artery. Aspirin works much the same way as Heparin. -Mary Whitmore #: 763531 S2/News and Newcomers (CIS:DIABETES) 24-Oct-97 13:57:03 Sb: Aspirin Use Urged Fm: Bruce Beale 100345,3667 To: WIZOP-Dave Groves 76703,4223 Replies: 0 TID: 108266 Par: 763388 Chd: 0 Sib: 0 >> Bayer a major diabusiness participant they should recommend aspirin and not follow Harvard's recommendations for alcohol. << Well aspirin will kill a significant number of dm stroke victims who like me have had a bleed rather than a blockage. Isn't the generic name for aspirin "Bayer" in many parts of the world? Bruce, UK -Bruce Beale #: 763652 S2/News and Newcomers (CIS:DIABETES) 24-Oct-97 21:59:19 Sb: Aspirin Use Urged Fm: WIZOP-Dave Groves 76703,4223 To: Bruce Beale 100345,3667 Replies: 0 TID: 108266 Par: 763531 Chd: 0 Sib: 0 Yup, almost like Kleenex is tissue! #: 763841 S2/News and Newcomers (CIS:DIABETES) 25-Oct-97 17:29:03 Sb: Aspirin Use Urged Fm: Mary Whitmore 73364,2375 To: Bruce Beale 100345,3667 Replies: 0 TID: 108266 Par: 763531 Chd: 0 Sib: 0 >> bleed rather than a blockage << Yep, aspirin will make that worse! -Mary Whitmore (Message in Diabetes) #: 764048 S2/News and Newcomers (CIS:DIABETES) 26-Oct-97 14:37:08 Sb: Aspirin Use Urged Fm: SYSOP-Paula DuBourdieu 73021,567 To: Mary Whitmore 73364,2375 Replies: 0 TID: 108266 Par: 763840 Chd: 0 Sib: 0 Dear Mary, Yes, but I've been thinking about some of the hypotheses that some of the value of aspirin may be in reducing inflammation in the blood vessel walls, particularly if bacteria plays a very strong role in atherosclerosis. I think it was in June '96 that Dr. Basil Rifkind of the National Heart, Lung and Blood Institute commented on the Muhlestein study and was quoted as saying that they are impressed and "very interested in this idea" and are taking it "quite seriously." I wish we could see a lot more research on this theory soon. Paula ===== ""Detection of Chlamydia pneumoniae in Human Nonrheumatic Stenotic Aortic Valves"" by Jukka Juvonene, MD, et al (Finland), published in the J Am Coll Cardiol 1997;29:1054-9 (April, 1997). Abstract: Objectives. We sought to study the possible presence of Chlamydia pneumoniae in aortic valve stenosis (AVS). Background. Inflammation and immune mechanisms are considered important for the pathogenesis of nonrheumatic AVS. All chlamydial species are able to cause heart infections, and seroepidemiologic studies have indicated an association between chronic C. pneumoniae infection and coronary artery disease. Furthermore, the organism has been demonstrated in atherosclerotic lesions. Methods. Aortic valve specimens with varying degrees of macroscopic disease were obtained from 35 subjects---17 consecutive patients undergoing aortic valve replacement for treatment of nonrheumatic AVS and 18 age-matched subjects at autopsy. The possible presence of C. pneumoniae in aortic valves was studied by immunohistochemical analysis, polymerase chain reaction or transmission electron microscopy, or a combination of these. Results. Positive immunohistochemical staining with C. pneumoniae specific antibody was found in 9 (53%) of 17 patients with advanced aortic valve disease requiring surgical treatment (group A), 8 (80%) of 10 cadavers with clearly macroscopic aortic valve pathology (group B) and 1 (12%) of 8 grossly normal cadaver control subjects (group C). Statistical significance with regard to the presence of C. pneumoniae was found when combined diseased subjects (groups A and B: total 17 of 27 subjects) were compared with group C (p = 0.018). However, when group A was compared with group C, there was only marginal statistical significance (p = 0.088). Finally, there was a strong statistical significance (p = 0.015) when groups B and C were compared. Chlamydia pneumoniae DNA was also found in three stenotic valves, and in two of the three tested valve specimens chlamydia-like particles were seen by electron microscopy. Conclusions. Chlamydia pneumoniae is frequently present in nonrheumatic AVS. Similarly, the high number of C. pneumoniae infections detected in the early lesions of ""degenerative"" AVS suggest that this pathogen may play an etiologic role in the development of this disease. The validity of this relation requires additional study. ==== "Increased Incidence of Chlamydia Species Within the Coronary Arteries of Patients With Symptomatic Atherosclerotic Versus Other Forms of Cardiovascular Disease" by Muhlestein et al, published in the J Am Coll Cardiol 1996;27:1555-61 (June 7, 1996). Abstract: Objectives. The objectives of this study were to test prospectively for an association between Chlamydia and atherosclerosis by comparing the incidence of the pathogen found within atherosclerotic plaques in patients undergoing directional coronary atherectomy with a variety of control specimens and comparing the clinical features between the groups. Background. Previous work has suggested an association between Chlamydia pneumoniae infection and coronary atherosclerosis, based on the demonstration of increased serologic titers and the detection of bacteria within atherosclerotic tissue, but this association has not yet been regarded as established. Methods. Coronary specimens from 90 symptomatic patients undergoing coronary atherectomy were tested for the presence of Chlamydia species using direct immunofluorescence. Control specimens from 24 subjects without atherosclerosis (12 normal coronary specimens and 12 coronary specimens from cardiac transplant recipients with subsequent transplant-induced coronary disease) were also examined. Results. Coronary atherectomy specimens were definitely positive in 66 (73%) and equivocally positive in 5 (6%), resulting in 79% of specimens showing evidence for the presence of Chlamydia species within the atherosclerotic tissue. In contrast, only 1 (4%) of 24 nonatherosclerotic coronary specimens showed any evidence of Chlamydia. The statistical significance of this difference is a p value <0.001. Transmission electron microscopy was used to confirm the presence of appropriate organisms in three of five positive specimens. No clinical factors except the presence of a primary nonrestenotic lesion (odds ratio 3.0, p = 0.057) predicted the presence of Chlamydia. Conclusions. This high incidence of Chlamydia only in coronary arteries diseased by atherosclerosis suggests an etiologic role for Chlamydia infection in the development of coronary atherosclerosis that should be further studied.