Question regarding aspirin

See foot of page

innatehealth.comcell signalling.htmOpen ↗

Best wishes,

Warren Ward

Stephen Nagler <[email hidden]> wrote in message
news:<[email hidden]>...

Quoted message said:

A question, please -

For individuals who - for whatever reason - cannot take aspirin, what are the current alternatives
that offer the same or at least a similar degree of protection against cardiac events? If
possible, please discuss advantages and disadvantages of each.

Thnx in advance -

smn

Stephen Nagler schrieb:

Quoted message said:

A question, please -

For individuals who - for whatever reason - cannot take aspirin, what are the current alternatives
that offer the same or at least a similar degree of protection against cardiac events? If
possible, please discuss advantages and disadvantages of each.

Perhaps they might want to consider eating fatty fish several times a week and consuming at least
one tablespoon of flaxseed oil every day.

The omega-3 fatty acids in both help to produce anti-inflammatory and anti-platlet aggregation
eicosanoids.

These individuals might also consider to cut back on food that contains arachidonic acid as this
acid helps to produce eicosanoids that counter the effects of the eicosanoids from the omega-3 fatty
acids. Arachidonic acid can be found in fatty meat and eggs.

Advantages: There is a lot of evidence that omega-3 fatty acids help prevent heart disease (see for
example Nurses' Health Study, Lion Diet Heart Study). They also might attenuate many other chronic
conditions where inflammation is involved like asthma.

Thorsten

--
"Nothing in biology makes sense, except in the light of evolution"

(Theodosius Dobzhansky)

On 15 Jan 2004 14:15:43 -0800, [email hidden]

(Warren Ward) said:

See foot of page

innatehealth.comcell signalling.htmOpen ↗

Best wishes,

Warren Ward

.............

Thank you for the kindness of a response. Appreciate it.

smn

Thorsten Schier said:

Perhaps they might want to consider eating fatty fish several times a week and consuming at least
one tablespoon of flaxseed oil every day.

The omega-3 fatty acids in both help to produce anti-inflammatory and anti-platlet aggregation
eicosanoids.

These individuals might also consider to cut back on food that contains arachidonic acid as this
acid helps to produce eicosanoids that counter the effects of the eicosanoids from the omega-3
fatty acids. Arachidonic acid can be found in fatty meat and eggs.

Advantages: There is a lot of evidence that omega-3 fatty acids help prevent heart disease (see for
example Nurses' Health Study, Lion Diet Heart Study). They also might attenuate many other chronic
conditions where inflammation is involved like asthma.

Thorsten

...............

Thnx. It's something to seriously consider.

But I'm asked quite frequently about a *medication* that might be used in lieu of aspirin in such
cases. My response has been to consider Plavix *if your doctor thinks it reasonable and appropriate*
- but I do wonder what the various alternatives are - especially since Plavix is so expensive.

Any thoughts?

smn

Stephen Nagler <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

A question, please -

For individuals who - for whatever reason - cannot take aspirin, what are the current alternatives
that offer the same or at least a similar degree of protection against cardiac events? If
possible, please discuss advantages and disadvantages of each.

How about natural vitamin E? That is what my doctor advised me to do. Aside from that, there are
herb pills produced by US multinationals in China. But i am not sure if they are available where you
are. They are actually very good but a bit more expensive than aspirin.

FP
================================

Quoted message said:

Thnx in advance -

smn

Thorsten Schier said:

Stephen Nagler schrieb:

Quoted message said:

A question, please -

For individuals who - for whatever reason - cannot take aspirin, what are the current
alternatives that offer the same or at least a similar degree of protection against cardiac
events? If possible, please discuss advantages and disadvantages of each.

Perhaps they might want to consider eating fatty fish several times a week and consuming at least
one tablespoon of flaxseed oil every day.

The omega-3 fatty acids in both help to produce anti-inflammatory and anti-platlet aggregation
eicosanoids.

These individuals might also consider to cut back on food that contains arachidonic acid as this
acid helps to produce eicosanoids that counter the effects of the eicosanoids from the omega-3
fatty acids. Arachidonic acid can be found in fatty meat and eggs.

Omega-3 fatty acids are *not* an appropriate substitute for aspirin for MI prevention.

They have *not* been shown to prevent coronary events

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
heartmdphd.comheartmdphd.comOpen ↗

francispoon said:

Stephen Nagler <[email hidden]> wrote in message
news:<[email hidden]>...

Quoted message said:

A question, please -

For individuals who - for whatever reason - cannot take aspirin, what are the current
alternatives that offer the same or at least a similar degree of protection against cardiac
events? If possible, please discuss advantages and disadvantages of each.

How about natural vitamin E?

Not an acceptible alternative.

Quoted message said:

That is what my doctor advised me to do.

Your doctor is not basing his/her advice on clinical evidence.

Quoted message said:

Aside from that, there are herb pills produced by US multinationals in China. But i am not sure
if they are available where you are. They are actually very good but a bit more expensive than
aspirin.

This would be a good example of paying more for less.

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
heartmdphd.comheartmdphd.comOpen ↗

MD/PhD said:

Omega-3 fatty acids are *not* an appropriate substitute for aspirin for MI prevention.

They have *not* been shown to prevent coronary events

...............

Dr. Chung -

Would you have any thoughts on what medications might be acceptable as substitutes for aspirin in
this setting? It is a topic that comes up not in frequently in my own clinic - so I suspect that it
is an issue of interest or concern to a fair percentage of tinnitus sufferers and others who might
wish to avoid aspirin for any of a variety of reasons.

Thank you.

smn

Vitamin E has been complained about by a few of being "addictive" Some, after taking large doses for
a few years, claimed they could not stop due to ill health upon trying to escape from this
supplementation.

It may be good to keep vitamin E to a "normalized" dosage and blend with other supplements.

Everything in moderation.

"francispoon" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

Stephen Nagler <[email hidden]> wrote in message

news:<[email hidden]>...

Quoted message said:

Quoted message said:

A question, please -

For individuals who - for whatever reason - cannot take aspirin, what are the current
alternatives that offer the same or at least a similar degree of protection against cardiac
events? If possible, please discuss advantages and disadvantages of each.

How about natural vitamin E? That is what my doctor advised me to do. Aside from that, there are
herb pills produced by US multinationals in China. But i am not sure if they are available where
you are. They are actually very good but a bit more expensive than aspirin.

FP
================================

Quoted message said:

Thnx in advance -

smn

"Dr. Andrew B. Chung, MD/PhD" schrieb:

Quoted message said:

Thorsten Schier said:

Stephen Nagler schrieb:

Quoted message said:

A question, please -

For individuals who - for whatever reason - cannot take aspirin, what are the current
alternatives that offer the same or at least a similar degree of protection against cardiac
events? If possible, please discuss advantages and disadvantages of each.

Perhaps they might want to consider eating fatty fish several times a week and consuming at
least one tablespoon of flaxseed oil every day.

The omega-3 fatty acids in both help to produce anti-inflammatory and anti-platlet aggregation
eicosanoids.

These individuals might also consider to cut back on food that contains arachidonic acid as this
acid helps to produce eicosanoids that counter the effects of the eicosanoids from the omega-3
fatty acids. Arachidonic acid can be found in fatty meat and eggs.

Omega-3 fatty acids are *not* an appropriate substitute for aspirin for MI prevention.

Omega-3 fatty acids and aspirin both work by altering the eicosanoid production. Aspirin blocks the
production of certain eicosanoids and omega-3 fatty acids promote the production of some eicosanoids
and block the production of others. As far as platlet aggregation is concerned, both work in the
same direction: they reduce the aggregation. Of course, omega-3 fatty acids do much more.

Quoted message said:

They have *not* been shown to prevent coronary events

There is a lot of evidence that they do. Would suggest that you read a few articles on medline. To
get you started:

ALA in the Nurses' Health Study:

Dietary intake of alpha-linolenic acid and risk of fatal ischemic heart disease among women

"During 10 y of follow-up, we documented 232 cases of fatal IHD and 597 cases of nonfatal myocardial
infarction. After adjustment for age, standard coronary risk factors, and dietary intake of linoleic
acid and other nutrients, a higher intake of -linolenic acid was associated with a lower relative
risk (RR) of fatal IHD; the RRs from the lowest to highest quintiles were 1.0, 0.99, 0.90, 0.67, and
0.55 (95% CI: 0.32, .94; P for trend = 0.01). "

ajcn.org890Open ↗
(tinyurl.com2lmz9Open ↗)

A clinical trial:

n-3 Fatty acids and 5-y risks of death and cardiovascular disease events in patients with coronary
artery disease

"Results: During the follow-up, 36 patients died, 21 had myocardial infarctions, and 12 had strokes.
The relative risks (RRs) of death adjusted for cardiovascular disease risk factors for subjects in
the highest tertile of fatty acids in CEs compared with those in the lowest tertile were 0.33 (95%
CI: 0.11, 0.96) for -linolenic acid, 0.33 (0.12, .93) for eicosapentaenoic acid, and 0.31 (0.11,
0.87) for docosahexaenoic acid (P for trend = 0.063, 0.056, and 0.026, respectively). "

Lyon Diet Heart Study:

"Methods and Results—Three composite outcomes (COs) combining either cardiac death and nonfatal
myocardial infarction (CO 1), or the preceding plus major secondary end points (unstable angina,
stroke, heart failure, pulmonary or peripheral embolism) (CO 2), or the preceding plus minor events
requiring hospital admission (CO 3) were studied. In the Mediterranean diet group, CO 1 was reduced
(14 events versus 44 in the prudent Western-type diet group, P=0.0001), as were CO
2 (27events versus 90, P=0.0001) and CO 3 (95 events versus 180, P=0.0002). Adjusted risk ratios
ranged from 0.28 to 0.53. Among the traditional risk factors, total cholesterol (1 mmol/L
being associated with an increased risk of 18% to 28%), systolic blood pressure (1 mm Hg being
associated with an increased risk of 1% to 2%), leukocyte count (adjusted risk ratios ranging
from 1.64 to 2.86 with count >9x109/L),

(adjusted risk ratios, 0.59 to 0.82) were each significantly and independently associated with
recurrence. "

A major difference between the intervention group and the controll grouo was the higher intake of
alpha-linolenic acid in the intervention group. While this does not prove that the linolenic acid is
responsible for the low risk of the intervention group, it does show that diet can be quite
effective in reducing the risk of heart disease, in this case even more so than the use of aspirin.

Much more of this at Medline.

Thorsten

--
"Nothing in biology makes sense, except in the light of evolution"

(Theodosius Dobzhansky)

Thu, 15 Jan 2004 14:02:48 GMT in article
<[email hidden]> Stephen Nagler <[email hidden]>

Quoted message said:

A question, please -

For individuals who - for whatever reason - cannot take aspirin, what are the current alternatives
that offer the same or at least a similar degree of protection against cardiac events? If possible,
please discuss advantages and disadvantages of each.

Well, one could try a combination of hot cocoa made in soy milk and sweetened with stevia, high dose
fish oil (EPA+DHA >= 5g/d; relatively high dose is required for optimizing the anti-inflammatory
effect), natural vitamin E, garlic or aged garlic supplements, and ginger powder mixed in liquid
(ginger is anti-inlammatory substance, it inhibits COX and 5-lipoxygenase).

Below some references about antiplatelet activity of cocoa/dark chocolate and garlic and about some
other effect of garlic:

1: Innes AJ, Kennedy G, McLaren M, Bancroft AJ, Belch JJ. Dark chocolate inhibits platelet
aggregation in healthy volunteers. Platelets. 2003 Aug; 14(5): 325-7. PMID: 12944249 [PubMed -
in process] <URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uid-
s=12944249&dopt=Abstract>

2: Murphy KJ, Chronopoulos AK, Singh I, Francis MA, Moriarty H, Pike MJ, Turner H, Mann NJ,
Sinclair AJ. Dietary flavanols and procyanidin oligomers from cocoa (Theobroma cacao) inhibit
platelet function. Am J Clin Nutr. 2003 Jun; 77(6): 1466-73. PMID: 12791625 [PubMed - indexed
for MEDLINE] <URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ui-
ds=12791625&dopt=Abstract>

3: Steinberg FM, Bearden MM, Keen CL. Cocoa and chocolate flavonoids: implications for
cardiovascular health. J Am Diet Assoc. 2003 Feb; 103(2): 215-23. Review. PMID: 12589329
[PubMed - indexed for MEDLINE]
<URL:http://www2.us.elsevierhealth.com/scripts/om.dll/serve?retrieve=/pii/S0002822302000329&>

4: Pearson DA, Paglieroni TG, Rein D, Wun T, Schramm DD, [censored] JF, Holt RR, Gosselin R, Schmitz HH,
Keen CL. The effects of flavanol-rich cocoa and aspirin on ex vivo platelet function. Thromb
Res. 2002 May 15; 106(4-5): 191-7. PMID: 12297125 [PubMed - indexed for MEDLINE] <URL:http://w-
ww.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12297125&dopt=Abstract>

5: Holt RR, Schramm DD, Keen CL, Lazarus SA, Schmitz HH. Chocolate consumption and platelet
function. JAMA. 2002 May 1; 287(17): 2212-3. PMID: 11980520 [PubMed - indexed for MEDLINE] <URL:http://jama.ama-
assn.org/cgi/content/full/287/17/2212>

6: Kris-Etherton PM, Keen CL. Evidence that the antioxidant flavonoids in tea and cocoa are
beneficial for cardiovascular health. Curr Opin Lipidol. 2002 Feb; 13(1): 41-9. Review. PMID:
11790962 [PubMed - indexed for MEDLINE] <URL:http://www.lwwonline.com/article.asp?ISSN=0957-
9672&VOL=13&ISS=1&PAGE=41>

7: Keen CL. Chocolate: food as medicine/medicine as food. J Am Coll Nutr. 2001 Oct; 20(5 Suppl):
436S-439S; discussion 440S-442S. Review. PMID: 11603654 [PubMed - indexed for MEDLINE]
<URL:http://www.jacn.org/cgi/content/full/20/suppl_5/436S>

8: Teranishi K, Apitz-Castro R, Robson SC, Romano E, Cooper DK. R Inhibition of baboon platelet
aggregation in vitro and in vivo by the garlic derivative, ajoene. Xenotransplantation. 2003
Jul; 10(4): 374-9. PMID: 12795687 [PubMed - in process] <URL:http://www.ncbi.nlm.nih.gov/entre-
z/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12795687&dopt=Abstract>

9: Hodge G, Hodge S, Han P. Allium sativum (garlic) suppresses leukocyte inflammatory cytokine
production in vitro: potential therapeutic use in the treatment of inflammatory bowel
disease. Cytometry. 2002 Aug 1; 48(4): 209-15. PMID: 12210145 [PubMed - indexed for MEDLINE]
<URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12210145-
&dopt=Abstract>

10: Ackermann RT, Mulrow CD, Ramirez G, Gardner CD, Morbidoni L, Lawrence VA. Garlic shows promise
for improving some cardiovascular risk factors. Arch Intern Med. 2001 Mar 26; 161(6): 813-24.
Review. PMID: 11268223 [PubMed - indexed for MEDLINE] <URL:http://www.ncbi.nlm.nih.gov/entrez/-
query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11268223&dopt=Abstract>

11: Steiner M, Li W. Related Articles, Links Aged garlic extract, a modulator of cardiovascular
risk factors: a dose-finding study on the effects of AGE on platelet functions. J Nutr. 2001
Mar; 131(3s): 980S-4S. PMID: 11238801 [PubMed - indexed for MEDLINE]
<URL:http://www.nutrition.org/cgi/content/full/131/3/980S>

12: Rahman K, Billington D. Dietary supplementation with aged garlic extract inhibits ADP-induced
platelet aggregation in humans. J Nutr. 2000 Nov; 130(11): 2662-5. PMID: 11053504 [PubMed -
indexed for MEDLINE] <URL:http://www.nutrition.org/cgi/content/full/130/11/2662>

13: Rahman K. Historical perspective on garlic and cardiovascular disease. J Nutr. 2001 Mar;
131(3s): 977S-9S. Review. PMID: 11238800 [PubMed - indexed for MEDLINE]
<URL:http://www.nutrition.org/cgi/content/full/131/3/977S>

14: Amagase H, Petesch BL, Matsuura H, Kasuga S, Itakura Y. Intake of garlic and its bioactive
components. J Nutr. 2001 Mar; 131(3s): 955S-62S. Review. PMID: 11238796 [PubMed - indexed for
MEDLINE] <URL:http://www.nutrition.org/cgi/content/full/131/3/955S>

15: Patumraj S, Tewit S, Amatyakul S, Jariyapongskul A, Maneesri S, Kasantikul V, Shepro D.
Comparative effects of garlic and aspirin on diabetic cardiovascular complications. Drug Deliv.
2000 Apr-Jun; 7(2): 91-6. PMID: 10892409 [PubMed - indexed for MEDLINE] <URL:http://www.ncbi.n-
lm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10892409&dopt=Abstract>

16: Ali M, Thomson M, Afzal M. Garlic and onions: their effect on eicosanoid metabolism and its
clinical relevance. Prostaglandins Leukot Essent Fatty Acids. 2000 Feb; 62(2): 55-73. Review.
PMID: 10780871 [PubMed - indexed for MEDLINE] <URL:http://www.ncbi.nlm.nih.gov/entrez/query.fc-
gi?cmd=Retrieve&db=PubMed&list_uids=10780871&dopt=Abstract>

17: Siegel G, Walter A, Engel S, Walper A, Michel F. [Pleiotropic effects of garlic] Wien Med
Wochenschr. 1999; 149(8-10): 217-24. Review. German. PMID: 10483684 [PubMed - indexed for
MEDLINE] <URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1-
0483684&dopt=Abstract>

18: Ali M, Bordia T, Mustafa T. Effect of raw versus boiled aqueous extract of garlic and onion on
platelet aggregation. Prostaglandins Leukot Essent Fatty Acids. 1999 Jan; 60(1): 43-7. PMID:
10319916 [PubMed - indexed for MEDLINE] <URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd-
=Retrieve&db=PubMed&list_uids=10319916&dopt=Abstract>

--
Matti Narkia

On Sat, 17 Jan 2004 15:51:04 +0200, Matti Narkia <[email hidden]>

Quoted message said:

Well, one could try a combination of hot cocoa made in soy milk and sweetened with stevia, high
dose fish oil (EPA+DHA >= 5g/d; relatively high dose is required for optimizing the anti-
inflammatory effect), natural vitamin E, garlic or aged garlic supplements, and ginger powder mixed
in liquid (ginger is anti-inlammatory substance, it inhibits COX and 5-lipoxygenase).

Below some references about antiplatelet activity of cocoa/dark chocolate and garlic and about some
other effect of garlic:

[snip]

..................

Thanks so much for running this stuff down, Matti. I read all the abstracts (except #5) ... and I
have a new appreciation for garlic and chocolate.

I think there may be real potential there, but one concern is commercially available garlic and
chocolate are not standardized and are not subject to FDA controls. A second concern, having read
the articles, is that as I see it none really compares the specific effects of garlic/chololate
against aspirin vis a vis mechanism of action in a dose-related manner.

Still and all - lots to think about. Really appreciate it.

smn

Sat, 17 Jan 2004 15:51:04 +0200 in article
<[email hidden]> Matti Narkia <[email hidden]>

Quoted message said:

Thu, 15 Jan 2004 14:02:48 GMT in article <[email hidden]> Stephen

Nagler said:

A question, please -

For individuals who - for whatever reason - cannot take aspirin, what are the current alternatives
that offer the same or at least a similar degree of protection against cardiac events? If
possible, please discuss advantages and disadvantages of each.

Well, one could try a combination of hot cocoa made in soy milk and sweetened with stevia, high
dose fish oil (EPA+DHA >= 5g/d; relatively high dose is required for optimizing the anti-
inflammatory effect), natural vitamin E, garlic or aged garlic supplements, and ginger powder mixed
in liquid (ginger is anti-inlammatory substance, it inhibits COX and 5-lipoxygenase).

Below some references about antiplatelet activity of cocoa/dark chocolate and garlic and about some
other effect of garlic:

Curcumin also inhibits platelet aggregation. Below some references about ginger and curcumin:

1: Nurtjahja-Tjendraputra E, Ammit AJ, Roufogalis BD, Tran VH, Duke CC. Effective anti-platelet
and COX-1 enzyme inhibitors from pungent constituents of ginger. Thromb Res. 2003; 111(4-5):
259-65. PMID: 14693173 [PubMed - in process] <URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcg-
i?cmd=Retrieve&db=PubMed&list_uids=14693173&dopt=Abstract>

2: Thomson M, Al-Qattan KK, Al-Sawan SM, Alnaqeeb MA, Khan I, Ali M. The use of ginger (Zingiber
officinale Rosc.) as a potential anti-inflammatory and antithrombotic agent. Prostaglandins
Leukot Essent Fatty Acids. 2002 Dec; 67(6): 475-8. PMID: 12468270 [PubMed - indexed for
MEDLINE] <URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1-
2468270&dopt=Abstract>

3: Koo KL, Ammit AJ, Tran VH, Duke CC, Roufogalis BD. Gingerols and related analogues inhibit
arachidonic acid-induced human platelet serotonin release and aggregation. Thromb Res. 2001 Sep
1; 103(5): 387-97. PMID: 11553371 [PubMed - indexed for MEDLINE] <URL:http://www.ncbi.nlm.nih.-
gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11553371&dopt=Abstract>

4: Bordia A, Verma SK, Srivastava KC. Effect of ginger (Zingiber officinale Rosc.) and fenugreek
(Trigonella foenumgraecum L.) on blood lipids, blood sugar and platelet aggregation in patients
with coronary artery disease. Prostaglandins Leukot Essent Fatty Acids. 1997 May; 56(5): 379-
84. PMID: 9175175 [PubMed - indexed for MEDLINE] <URL:http://www.ncbi.nlm.nih.gov/entrez/query-
.fcgi?cmd=Retrieve&db=PubMed&list_uids=11553371&dopt=Abstract>

5: Guh JH, Ko FN, Jong TT, Teng CM. Antiplatelet effect of gingerol isolated from Zingiber
officinale. J Pharm Pharmacol. 1995 Apr; 47(4): 329-32. PMID: 7791032 [PubMed - indexed for
MEDLINE] <URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7-
791032&dopt=Abstract>

6: Lumb AB. Effect of dried ginger on human platelet function. Thromb Haemost. 1994 Jan; 71(1):
110-1. PMID: 8165628 [PubMed - indexed for MEDLINE] <URL:http://www.ncbi.nlm.nih.gov/entrez/qu-
ery.fcgi?cmd=Retrieve&db=PubMed&list_uids=8165628&dopt=Abstract>

7: Verma SK, Singh J, Khamesra R, Bordia A. Effect of ginger on platelet aggregation in man.
Indian J Med Res. 1993 Oct; 98: 240-2. PMID: 8119760 [PubMed - indexed for MEDLINE] <URL:h-
ttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8119760&dopt-
=Abstract>

8: Srivastava KC. Effect of onion and ginger consumption on platelet thromboxane production in
humans. Prostaglandins Leukot Essent Fatty Acids. 1989 Mar; 35(3): 183-5. PMID: 2710801 [PubMed
- indexed for MEDLINE] <URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubM-
ed&list_uids=2710801&dopt=Abstract>

9: Srivastava KC. Isolation and effects of some ginger components of platelet aggregation and
eicosanoid biosynthesis. Prostaglandins Leukot Med. 1986 Dec; 25(2-3): 187-98. PMID: 3103137
[PubMed - indexed for MEDLINE] <URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve-
&db=PubMed&list_uids=3103137&dopt=Abstract>

10: Suekawa M, Yuasa K, Isono M, Sone H, Ikeya Y, Sakakibara I, Aburada M, Hosoya E.
[Pharmacological studies on ginger. IV. Effect of (6)-shogaol on the arachidonic cascade]
Nippon Yakurigaku Zasshi. 1986 Oct; 88(4): 263-9. Japanese. PMID: 3098654 [PubMed - indexed for
MEDLINE] <URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3-
098654&dopt=Abstract>

11: Srivas KC. Effects of aqueous extracts of onion, garlic and ginger on platelet aggregation and
metabolism of arachidonic acid in the blood vascular system: in vitro study. Prostaglandins
Leukot Med. 1984 Feb; 13(2): 227-35. PMID: 6425866 [PubMed - indexed for MEDLINE] <URL:http://-
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6425866&dopt=Abstract>

12: Srivastava KC. Aqueous extracts of onion, garlic and ginger inhibit platelet aggregation and
alter arachidonic acid metabolism. Biomed Biochim Acta. 1984; 43(8-9): S335-46. PMID: 6440548
[PubMed - indexed for MEDLINE] <URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve-
&db=PubMed&list_uids=6440548&dopt=Abstract>

13: Shah BH, Nawaz Z, Pertani SA, Roomi A, Mahmood H, Saeed SA, Gilani AH. Inhibitory effect of
curcumin, a food spice from turmeric, on platelet-activating factor- and arachidonic acid-
mediated platelet aggregation through inhibition of thromboxane formation and Ca2+ signaling.
Biochem Pharmacol. 1999 Oct 1; 58(7): 1167-72. PMID: 10484074 [PubMed - indexed for MEDLINE]
<URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10484074&d-
opt=Abstract>

14: Srivastava KC, Bordia A, Verma SK. Curcumin, a major component of food spice turmeric (Curcuma
longa) inhibits aggregation and alters eicosanoid metabolism in human blood platelets.
Prostaglandins Leukot Essent Fatty Acids. 1995 Apr; 52(4): 223-7. PMID: 7784468 [PubMed -
indexed for MEDLINE] <URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed-
&list_uids=7784468&dopt=Abstract>

15: Ammon HP, Safayhi H, Mack T, Sabieraj J. Mechanism of antiinflammatory actions of curcumine and
boswellic acids. J Ethnopharmacol. 1993 Mar; 38(2-3): 113-9. PMID: 8510458 [PubMed - indexed
for MEDLINE] <URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ui-
ds=8510458&dopt=Abstract>

16: Srivastava R, Puri V, Srimal RC, Dhawan BN. Effect of curcumin on platelet aggregation and
vascular prostacyclin synthesis. Arzneimittelforschung. 1986 Apr; 36(4): 715-7. PMID: 3521617
[PubMed - indexed for MEDLINE <URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&-
db=PubMed&list_uids=3521617&dopt=Abstract>

--
Matti Narkia

Stephen Nagler <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

Thorsten Schier said:

Perhaps they might want to consider eating fatty fish several times a week and consuming at least
one tablespoon of flaxseed oil every day.

The omega-3 fatty acids in both help to produce anti-inflammatory and anti-platlet aggregation
eicosanoids.

These individuals might also consider to cut back on food that contains arachidonic acid as this
acid helps to produce eicosanoids that counter the effects of the eicosanoids from the omega-3
fatty acids. Arachidonic acid can be found in fatty meat and eggs.

Advantages: There is a lot of evidence that omega-3 fatty acids help prevent heart disease (see
for example Nurses' Health Study, Lion Diet Heart Study). They also might attenuate many other
chronic conditions where inflammation is involved like asthma.

Thorsten

...............

Thnx. It's something to seriously consider.

But I'm asked quite frequently about a *medication* that might be used in lieu of aspirin in such
cases. My response has been to consider Plavix *if your doctor thinks it reasonable and
appropriate* - but I do wonder what the various alternatives are - especially since Plavix is so
expensive.

Any thoughts?

smn

What about low dose warfarin?

Kathy

(Kathy) said:

What about low dose warfarin?

...............

Thank you.

I think some people do recommend it. I would think that "low dose" varies from person to person and
that protimes would have to be checked routinely. Warfarin also interacts with numerous other drugs,
requiring dosage alteration. Much much trickier to use in a long term prophylactic setting than
aspirin, in my opinion.

smn

"Dr. Andrew B. Chung, MD/PhD" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

francispoon said:

Stephen Nagler <[email hidden]> wrote in message
news:<[email hidden]>...

Quoted message said:

A question, please -

For individuals who - for whatever reason - cannot take aspirin, what are the current
alternatives that offer the same or at least a similar degree of protection against cardiac
events? If possible, please discuss advantages and disadvantages of each.

How about natural vitamin E?

Not an acceptible alternative.

So are you suggesting that aspirin is the only one? Could i take vitamin E and aspirin
intermittently as a prevention?

FP
========================================

Quoted message said:

Quoted message said:

That is what my doctor advised me to do.

Your doctor is not basing his/her advice on clinical evidence.

Quoted message said:

Aside from that, there are herb pills produced by US multinationals in China. But i am not sure
if they are available where you are. They are actually very good but a bit more expensive than
aspirin.

This would be a good example of paying more for less.

Humbly,

Andrew

18 Jan 2004 01:33:27 -0800 in article
<[email hidden]> [email hidden]

(francispoon) said:

"Dr. Andrew B. Chung, MD/PhD" <[email hidden]> wrote in message
news:<[email hidden]>...

Quoted message said:

francispoon said:

Stephen Nagler <[email hidden]> wrote in message
news:<[email hidden]>...
> A question, please -
>
> For individuals who - for whatever reason - cannot take aspirin, what are the current
> alternatives that offer the same or at least a similar degree of protection against cardiac
> events? If possible, please discuss advantages and disadvantages of each.

How about natural vitamin E?

Not an acceptible alternative.

So are you suggesting that aspirin is the only one? Could i take vitamin E and aspirin
intermittently as a prevention?

In some trials vitamin E has failed to show benefit, while aspirin has consistently shown benefit.
In epidemiological studies vitamin E has looked more promising. The reason for the its failure is
some trials is not known: it simply could lack efficacy, or perhaps synthetic alpha-tocopherol,
which some studies have used, is not as effective as the diet originated natural vitamin E, which in
addition to alpha-tocopherol includes also other tocopherols (gamma-tocopherol has got some
publicity recently) and tocotrienols. Also, according to some studies there is a great variation in
the absorption of vitamin E supplements; in addition to the type of the supplement the timing of the
supplementation is of great importance: if taken into empty stomach hardly anything is absorbed.
Vitamin E supplements should always be taken with the meal.

When taken _together_ with aspirin, vitamin E seems to potentiate aspirin's antiplatelet activity:

Celestini A, Pulcinelli FM, Pignatelli P, Lenti L, Frati G, Gazzaniga PP, Violi F. Vitamin E
potentiates the antiplatelet activity of aspirin in collagen-stimulated platelets. Haematologica.
2002 Apr; 87(4): 420-6. PMID: 11940487 [PubMed - indexed for MEDLINE] <URL:http://www.ncbi.nlm.nih.-
gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11940487&dopt=Abstract>

--
Matti Narkia

Kathy said:

Stephen Nagler <[email hidden]> wrote in message
news:<[email hidden]>...

Quoted message said:

Thorsten Schier said:

Perhaps they might want to consider eating fatty fish several times a week and consuming at
least one tablespoon of flaxseed oil every day.

The omega-3 fatty acids in both help to produce anti-inflammatory and anti-platlet aggregation
eicosanoids.

These individuals might also consider to cut back on food that contains arachidonic acid as
this acid helps to produce eicosanoids that counter the effects of the eicosanoids from the omega-
3 fatty acids. Arachidonic acid can be found in fatty meat and eggs.

Advantages: There is a lot of evidence that omega-3 fatty acids help prevent heart disease (see
for example Nurses' Health Study, Lion Diet Heart Study). They also might attenuate many other
chronic conditions where inflammation is involved like asthma.

Thorsten

...............

Thnx. It's something to seriously consider.

But I'm asked quite frequently about a *medication* that might be used in lieu of aspirin in
such cases. My response has been to consider Plavix *if your doctor thinks it reasonable and
appropriate* - but I do wonder what the various alternatives are - especially since Plavix is so
expensive.

Any thoughts?

smn

What about low dose warfarin?

Kathy

No, low dose warfarin does not prevent heart attacks, Kathy.

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
heartmdphd.comheartmdphd.comOpen ↗

francispoon said:

"Dr. Andrew B. Chung, MD/PhD" <[email hidden]> wrote in message
news:<[email hidden]>...

Quoted message said:

francispoon said:

Stephen Nagler <[email hidden]> wrote in message
news:<[email hidden]>...
> A question, please -
>
> For individuals who - for whatever reason - cannot take aspirin, what are the current
> alternatives that offer the same or at least a similar degree of protection against cardiac
> events? If possible, please discuss advantages and disadvantages of each.

How about natural vitamin E?

Not an acceptible alternative.

So are you suggesting that aspirin is the only one?

There are others but would suggest you ask your cardiologist for specific advice.

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
heartmdphd.comheartmdphd.comOpen ↗