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
>Since my father has suffered several small strokes and I am now 45 years old,
>my physician recommends that I begin taking what we used to call a "baby"
>aspirin everyday-I believe it is 81mgs.
>
>When I had voice surgery 4 years ago I distinctly remember the speech
>therapists warning me to avoid aspirin, since it can increase the chance of
>vocal fold hemorrhage. But what about this small dose? Would it also
>increase the risk of hemorrhage?
>
>For what it is worth, I am pre-menopausal (or at least peri--no symptoms as
>yet), and my cholesterol was 130. I do not smoke and drink only 2-3 glasses
>of wine per week and my blood pressure is very low--usually runs around
>80/50. I am also very small, which may account for the low blood pressure.
>However, my father is a non-smoker, tee-totaler, has low blood pressure and a
>normal cholesterol level, with a good HDL/LDL ratio. Why he had a stroke is
>beyond me.......
>
>I am not asking for anyone to make a medical decision for me, I really just
>want to know if that dosage of aspirin would be damaging to my voice.
>
>Thanks,
>Leslie
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