I can remember not too many years ago cardiac patients usually took aspirin as a preventative medication (anti platelet med) and if you were at a high risk for problems (and you could afford it) you took clopidogrel (Plavix). Both excellent and fairly safe drugs if used as recommended. Not long ago it became fashionable to give patients both drugs for added protection. Is that a good idea?

This week a study published in the Archives of Internal Medicine states that the risk of bleeding in these patients taking both medications is substantial and should be treated as such. Even though this approach is still safer than warfarin which is also prescribed for several cardiac problems, the risk needs to be recognized. 

In this study there were 7,764 emergency room visits among the dual treated patient group and most of those were for bleeding though usually minor. There were 40,924 warfarin treated patients for bleeding which were recorded for context. Once again most of this bleeding was also minor. The bleeding risk with warfarin is rarely ignored while the risk for dual anti platelet therapy is often down played or not recognized.

While the bleeding may not usually be serious in these patients on both aspirin and clopidogrel (Plavix), the risk is real and should be taken seriously by doctors and patients alike. The authors of the study also suggest that patients should be made aware of the risk of bleeding but stress that the risk is not a reason to abandon the therapy.

If you or a loved one is on both aspirin and clopidogrel (Plavix) you may want to discuss what you might expect with your prescriber. bjmdjd

Material modifications since posting: none

Archives of Internal Medicine · aspirin · Plavix · risk of bleeding · warfarin

You might feel that you are in pretty decent shape except for that few extra inches around your mid section. However, a study printed in the current issue of Archives of Internal Medicine begs to differ. Waist size in older adults is a mortality risk factor regardless of the all important body mass index (BMI).

The authors concluded that regardless of an older adults weight they should pay close attention to their waist circumference to avoid earlier mortality.

Material modifications since posting: none

Archives of Internal Medicine · body mass index (BMI) · health · waist circumference · wellness

For many years it was felt that nuts were an unhealthy snack. More recently many kinds of nuts have been found to be better for you than originally thought.

A recent study published in the Archives of Internal Medicine revealed that eating almost any kind of nut lowers total cholesterol levels and the bad kind LDL. The amount of lowering was found to be dependent on how many nuts were consumed. The authors of the study said that the risk of coronary artery disease was almost 40% lower in folks who ate at least four servings of nuts per week compared to those who rarely or never ate them.

It does seem that the benefits of eating nuts on cholesterol lowering was better in those who started with higher cholesterol levels. This study seems to support the 2003 statement by the Food and Drug Administration that the consumption of certain types of nuts might lower the risk of heart disease. The nuts mentioned at that time by the FDA included almonds, hazelnuts, pecans, pistachios, walnuts, and peanuts.  bjmdjd

Material modifications since posting: none

Archives of Internal Medicine · coronary artery disease · Food and Drug Administration · nuts can lower cholesterol