We have known for a while that taking one aspirin daily is effective in preventing heart attacks and strokes. A daily dose of 325 mg or a daily dose of 81 mg (baby aspirin) has been show to be effective. After putting all the studies together, it appears that 81 mg per day aspirin dose to be superior to the 325 mg dose. IF YOU DO NOT A HISTORY OF BLEEDING PROBLEMS, I recommend 81 mg per day of aspirin.

Fish Oils

For people with known heart disease or people at high risk of heart disease, I recommend eating cold water fish or taking fish oil capsules daily. There have been over 10 well done studies documenting the benefit in patients who have had a heart attack. The dose that I recommend you take is the dose that was used in the largest of these studies, called the GISSI-Prevenzione Trial. Take 1 capsule daily of about 850-882 mg of eicosapentanoic acid and docosahexanoic acid in a ratio of about 1:2 of eicosapentanoic acid to docosahexanoic acid. This dose was chosen to estimate the amount of the “good” n-3 polyunsaturated fatty acids in a daily serving (100 grams) of cold water fish. Although the studies did not omit the fish oil capsule on days when a serving of cold water fish is eaten, it makes sense to me to do that to save on your cost of the supplements.

It is not certain how fish oils prevent heart attacks and stokes. It may be by preventing blood clotting in arteries, preventing dangerous heart rhythms, or in some other way. Taking fish oils in these doses will not significantly change your cholesterol levels.

I have found these fish oils in local pharmacies for about $8.00 for 60 or 100 pills.

Based on the results of the 1.5 year long GISSI study, patients with the greatest risk of heart disease had the greatest benefit from taking the fish oils. For patients with the highest risk of a cardiovascular disease death (22% risk of death in 1.5 years), 24 high risk patients must take this dose of fish oils for 1.5 years to prevent 1 death. In the patients with the lowest cardiovascular disease death risk (1% risk of death in 1.5 years), 250 patients need to take the fish oils for 1.5 years to prevent 1 death.

Vitamin E

It had been widely believed that vitamin E prevented heart attacks and strokes because of its antioxidant activity. Early studies showed vitamin E to be beneficial. There was even a time when I recommended that patients take vitamin E because of these studies. I have since changed my recommendation to not use vitamin E based on the results of 3 more recent studies. The GISSI-Prevenione Trial showed no benefit (nor harm) in the 5000 patients who took 300 Units of vitamin E daily. The Hope study showed no benefit (nor harm) in the 5000 patients who took 400 Units of vitamin E daily. The most concerning finding was in the HATS study. The patients who took an antioxidant pill containing 800 Units of vitamin E daily has more progression of the heart disease than the subjects who took placebo (the fake pill). Therefore, I do not recommend you take vitamin E.

Vitamin C

Vitamin C is an antioxidant. I have not seen enough evidence to advise either for or against its use to prevent heart attacks or strokes.

Treatment of Homocysteine

Everyone is aware of high cholesterol and high blood pressure as risks for the development of stroke and heart attack. There has been a new risk factor identified, called homocysteine. Many, but not all, studies have shown an association between higher levels of a chemical in the blood called homocysteine and a person’s risk of having a heart attack, stroke, or peripheral vascular disease. At all levels, the higher the homocysteine levels, the greater the risk for heart attack or stroke. The greatest risk has been seen when homocysteine levels are over 14 micromoles/L. The magnitude of the risk for heart attack and stroke appears to be about 1.5 to 2 times in people with high homocysteine levels compared to people with lower levels.

Association of a risk factor with a disease does not necessarily mean that treating the risk factor will lower the risk. With the risk factors of high cholesterol and high blood pressure, studies have shown that lowering these risk factors does lead to a lower risk of stroke and heart attack. However, gray hair is also a well-known risk factor for stroke and heart attack. Yet changing that risk factor, for example dying your hair, will not in any way influence the risk of heart disease. Because this is a newly identified risk factor, studies have not yet been done to show that lowering the homocysteine level reduces the risk of heart disease. These studies are currently being done and we hope to have results in the next few years.

Although the proof that treating homocysteine lowers the risk of heart disease has not yet been presented, some people may choose to lower their homocysteine levels because treatment is not dangerous and consists of using over-the-counter vitamins (no prescription is needed). There are 3 vitamins that will lower homocysteine – folate, vitamin B12, and vitamin B6. It may be that you only will need to take one of the 3 vitamins to lower your heart disease risk, but since it has not yet been proven, it is reasonable to use all 3 doses that have been shown to be safe and effective while waiting for completion of the ongoing studies to guide dosing recommendations.

If you choose to lower your homocysteine level, a reasonable regimen is:

Folate 5 mg per day,
Vitamin B12 1 mg per day, and
Vitamin B6 anywhere from 250 to 600 mg per day.

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The American Cancer Society recommends all people over 50 years old be screened for colon cancer. They approve of 3 screening methods. Each of these 3 methods differ in their ability to detect cancer and their effort and inconvenience to you, the patient.

This page is intended to help you decide which of the 3 accepted colon cancer screening tests is best for you. The 3 colon cancer screening tests are 1) fecal occult blood test, 2) flexible sigmoidoscopy, and 3) colonoscopy.