Utility of Aspirin and Statins in Cardiovascular Diseases
Dr. Neel Khanna explores the use of aspirin and statins in the fight against cardiovascular disease and the differences between the two.
Featured Speaker:
Neel Khanna, MD
Neel Khanna, MD is an Interventional Cardiologist. Transcription:
Utility of Aspirin and Statins in Cardiovascular Diseases
Caitlin Whyte: Aspirin and statins have shown significant reduction of cardiovascular events and a low rate of side effects in many patients with heart issues. To tell us more is Dr. Neel Khanna, the Medical Director of the Cardiovascular Institute at Montefiore St. Luke's Cornwall.
This is Doc Talk, presented by Montefiore St. Luke's Cornwall. I'm your host, Caitlin Whyte. So doctor, you were telling me beforehand that many people take statins and aspirin together. What is the difference between these two medicines?
Neel Khanna, MD, MPH: Well, aspirin for one is a medication that is -- you know, some people call it a blood thinner. It really works against platelets and it prevents blood clots from forming in either the heart arteries or in the arteries that go to the brain. Whereas statin medications are not blood thinners. They don't make your blood any thinner, but they do help prevent plaque from building and the plaque that you do have in your either heart arteries or any arteries of the body, it does help stabilize those plaques so that they're less likely to, A, grow or, B, rupture and cause an event like a heart attack.
Caitlin Whyte: And how do they work together to support the cardiovascular system?
Neel Khanna, MD, MPH: So, you know, I'll speak on terms of heart attacks, but strokes are often very similar. When a heart attack happens, what usually is the scenario if someone has a plaque in their heart arteries and they don't know about it in most cases, and because of a certain stress and for some people it's doing exercise, the classic story is someone shoveling snow and getting their heart rate up, the plaque that's there and bulky tends to rupture. And on top of that rupture of that plaque, a blood clot forms, and that totally blocks the artery and then somebody suffers damage to the heart muscle because there's no blood flow through there.
So I think of the aspirin and the statin medication sort of as a team that link up. The statin medication will help stabilize that plaque from rupturing and will prevent it from getting big enough to cause problems to the individual. Whereas the aspirin will help prevent that blood clot from forming that extra 10% that will totally block the artery. So I view them as a duo in specific patients, in patients really who we know have heart disease or who have a very high risk of developing heart disease.
Caitlin Whyte: Well, that leads me into my next question. Who is this combo good for? What type of patient with what kind of issue?
Neel Khanna, MD, MPH: You know, one of the main things is that it doesn't necessarily mean that if you take one, you should be taking both. Often that's the case. You know, in anybody who has proven heart disease or significant plaque in their heart arteries, either because they've had an event in the past or because they've had a test that shows or they're having chest pain and they had a test that shows that they have significant plaque, I recommend or most doctors would recommend that they'd be on the combo medication on both aspirin and the cholesterol pill.
But in general, it used to be that, you know, people get beyond a certain age and everyone takes an aspirin. I think current thinking is that that's not the best way to go. If you have no history of heart disease, if you don't have major cardiovascular risk factors, such as high blood pressure and diabetes that are uncontrolled, it's very possible that taking an aspirin a day may not give you much benefit and may actually increase your risk of bleeding in the future. So, you know, it's not beneficial for you. So that's why it's very important for people to consult with their doctors, either their primary care doctor or a cardiologist if they have it to see if they would benefit from these.
What I do personally, and what most doctors do, is we calculate a patient's risk. We take into account their risk factors, their blood pressure, whether they're on blood pressure medications, whether they have diabetes, what their age is. And we calculate a risk score that show what is their chance of having either a cardiac event in the next 10 years or a stroke in the next 10 years? And if that number is above a certain level, let's say in most cases, people look at 10%. If someone's risk is more than 10%, we recommend that they be on this combo to help prevent it. But if you see your physician and you're not having many symptoms and your risk is less than that, is less than 10%, you know, is closer or even less than 5%, then very often you won't benefit from these medications and there is no real benefit to you being on them.
Caitlin Whyte: Gotcha. So it sounds like just another booster option if we're already on statins. Doctor, is there anything else that you'd like us to know about this combination as we wrap up?
Neel Khanna, MD, MPH: Yeah. I mean, one thing is very important that as we get older, definitely over the age of 40 and definitely over the age of 60, that it's to everyone's benefit to know what their cholesterol level is and to see particularly what their LVL is, which is the bad cholesterol traditionally it's been called, to know what that level is, because that is one of the most clear predictors of what your cardiac risk and what your risk of having a stroke in the future is.
So I recommend that people get that checked yearly if they're over a certain age at least. And if they have a history of a heart problem, a history of a stroke in the past or a heart attack, you know, we really should target the lowest possible targets for these numbers because they actually do really prevent repeat heart attacks or repeat strokes in the future. And it's a pretty simple medication to take once a day that could really prevent people from having significant heart problems in the future.
Caitlin Whyte: Well, thank you so much for sharing this with us doctor. That was Dr. Neel Khanna, the Medical Director of the Cardiovascular Institute at Montefiore St. Luke's Cornwall. Visit montefioreslc.org for more information about the Cardiovascular Institute. If you found this podcast helpful, please share it on your social channels and be sure to check out all the other Doc Talk episodes.
This has been Doc Talk, the podcast from Montefiore St. Luke's Cornwall Hospital. I'm Caitlin Whyte. Stay well.
Utility of Aspirin and Statins in Cardiovascular Diseases
Caitlin Whyte: Aspirin and statins have shown significant reduction of cardiovascular events and a low rate of side effects in many patients with heart issues. To tell us more is Dr. Neel Khanna, the Medical Director of the Cardiovascular Institute at Montefiore St. Luke's Cornwall.
This is Doc Talk, presented by Montefiore St. Luke's Cornwall. I'm your host, Caitlin Whyte. So doctor, you were telling me beforehand that many people take statins and aspirin together. What is the difference between these two medicines?
Neel Khanna, MD, MPH: Well, aspirin for one is a medication that is -- you know, some people call it a blood thinner. It really works against platelets and it prevents blood clots from forming in either the heart arteries or in the arteries that go to the brain. Whereas statin medications are not blood thinners. They don't make your blood any thinner, but they do help prevent plaque from building and the plaque that you do have in your either heart arteries or any arteries of the body, it does help stabilize those plaques so that they're less likely to, A, grow or, B, rupture and cause an event like a heart attack.
Caitlin Whyte: And how do they work together to support the cardiovascular system?
Neel Khanna, MD, MPH: So, you know, I'll speak on terms of heart attacks, but strokes are often very similar. When a heart attack happens, what usually is the scenario if someone has a plaque in their heart arteries and they don't know about it in most cases, and because of a certain stress and for some people it's doing exercise, the classic story is someone shoveling snow and getting their heart rate up, the plaque that's there and bulky tends to rupture. And on top of that rupture of that plaque, a blood clot forms, and that totally blocks the artery and then somebody suffers damage to the heart muscle because there's no blood flow through there.
So I think of the aspirin and the statin medication sort of as a team that link up. The statin medication will help stabilize that plaque from rupturing and will prevent it from getting big enough to cause problems to the individual. Whereas the aspirin will help prevent that blood clot from forming that extra 10% that will totally block the artery. So I view them as a duo in specific patients, in patients really who we know have heart disease or who have a very high risk of developing heart disease.
Caitlin Whyte: Well, that leads me into my next question. Who is this combo good for? What type of patient with what kind of issue?
Neel Khanna, MD, MPH: You know, one of the main things is that it doesn't necessarily mean that if you take one, you should be taking both. Often that's the case. You know, in anybody who has proven heart disease or significant plaque in their heart arteries, either because they've had an event in the past or because they've had a test that shows or they're having chest pain and they had a test that shows that they have significant plaque, I recommend or most doctors would recommend that they'd be on the combo medication on both aspirin and the cholesterol pill.
But in general, it used to be that, you know, people get beyond a certain age and everyone takes an aspirin. I think current thinking is that that's not the best way to go. If you have no history of heart disease, if you don't have major cardiovascular risk factors, such as high blood pressure and diabetes that are uncontrolled, it's very possible that taking an aspirin a day may not give you much benefit and may actually increase your risk of bleeding in the future. So, you know, it's not beneficial for you. So that's why it's very important for people to consult with their doctors, either their primary care doctor or a cardiologist if they have it to see if they would benefit from these.
What I do personally, and what most doctors do, is we calculate a patient's risk. We take into account their risk factors, their blood pressure, whether they're on blood pressure medications, whether they have diabetes, what their age is. And we calculate a risk score that show what is their chance of having either a cardiac event in the next 10 years or a stroke in the next 10 years? And if that number is above a certain level, let's say in most cases, people look at 10%. If someone's risk is more than 10%, we recommend that they be on this combo to help prevent it. But if you see your physician and you're not having many symptoms and your risk is less than that, is less than 10%, you know, is closer or even less than 5%, then very often you won't benefit from these medications and there is no real benefit to you being on them.
Caitlin Whyte: Gotcha. So it sounds like just another booster option if we're already on statins. Doctor, is there anything else that you'd like us to know about this combination as we wrap up?
Neel Khanna, MD, MPH: Yeah. I mean, one thing is very important that as we get older, definitely over the age of 40 and definitely over the age of 60, that it's to everyone's benefit to know what their cholesterol level is and to see particularly what their LVL is, which is the bad cholesterol traditionally it's been called, to know what that level is, because that is one of the most clear predictors of what your cardiac risk and what your risk of having a stroke in the future is.
So I recommend that people get that checked yearly if they're over a certain age at least. And if they have a history of a heart problem, a history of a stroke in the past or a heart attack, you know, we really should target the lowest possible targets for these numbers because they actually do really prevent repeat heart attacks or repeat strokes in the future. And it's a pretty simple medication to take once a day that could really prevent people from having significant heart problems in the future.
Caitlin Whyte: Well, thank you so much for sharing this with us doctor. That was Dr. Neel Khanna, the Medical Director of the Cardiovascular Institute at Montefiore St. Luke's Cornwall. Visit montefioreslc.org for more information about the Cardiovascular Institute. If you found this podcast helpful, please share it on your social channels and be sure to check out all the other Doc Talk episodes.
This has been Doc Talk, the podcast from Montefiore St. Luke's Cornwall Hospital. I'm Caitlin Whyte. Stay well.