Dear Listmates, Sorry!!I hit the "send" button before I finished this....This is the finished version.
To summarize---At 09:45 PM 9/20/02 EDT, leskayc, a middle-aged woman whose father has sustained several strokes, asks if there is vocal risk to taking low-dose (81mg) of aspirin daily. Both she and her father have low or normal blood pressures, lipids levels; and neither have a history of nicotine or alcohol abuse.
Leslie--
This is an interesting question. The answer is a bit complicated: The "correct" dose of aspirin for stroke prevention is unknown. Some neurologists insist on 325mg twice daily, while an equally fervent group adhere to the 81mg regimen. Evidence does suggest that 81mg is as effective as higher doses. Further, as I recall, the benefits of aspirin are proven in men, not women, although it is unclear to me why there should be a difference in this particular regard. For both stroke and heart attack prevention, the data in support of aspirin are for *secondary* prevention, ie., the benefit is for prevention of a *second* event in those who've already sustained a first event, regardless of other risk factors. There is currently no solid evidence to support aspirin for *primary* prevention, while there is evidence of risk of hemorrage, particularly if one has a predilection to hemorrhagic complications. Aspirin's benefits in stroke prevention are by virtue of its inhibition of platelets, the elements of blood responsible for initial clot formation (so-called "soft clot"). Hence, any dose of aspirin that will be effective in stroke or heart attack prevention is going to increase the risk of bleeding complications. It becomes a matter of balancing risks, then.
You should know that while HTN is a known and significant risk factor for stroke, cholesterol is not (at least, not yet). Methionine intolerance, however, has been found in as many as 40% of victims of stroke and peripheral vascular disease. Methionine, an essential amino acid, commonly found in meat, milk, eggs, cheese, etc., is normally metabolised to another amino acid, homocysteine. Homocysteine may accumulate to atherosclerosis-inducing levels in homocystinuria, as well as carriers of the gene for homocystinuria, or in individuals who for a variety of reasons may be deficient in folate (a vitamin) metabolism.
As I am not your physician, I cannot make specific recommendations. However, you may wish to consider foregoing the aspirin, especially in view of your speech therapist's previous recommendations, and asking your MD to consider prescribing 1mg folate daily, instead. Additionally, both you and your father may want to consider undergoing a "methionine tolerance test" in which you take a "Big Macs'" worth of methionine orally, and have your homocystine level checked an hour later.
GWendel, dT (MD, PhD, etc)
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