Expert Q&A

Ask The Doctor

We asked renowned cardiologist Michael Crawford, MD, to answer some of the most common questions that heart patients ask their doctors. Dr. Crawford is chief of clinical cardiology at the University of California, San Francisco, Medical Center; co-lead editor of the textbook Cardiology; and editor of Current Diagnosis and Treatment in Cardiology.

Q. Should I take a daily aspirin to reduce my risk of heart disease? 

A. The decision is complicated, especially for women. That’s because the data on aspirin’s effectiveness in women are not as compelling as they are in men. In women, aspirin has been shown to prevent strokes, but not heart attacks.
In men, the decision is a little more clear-cut. If you’re 40 or older and at risk for cardiovascular disease, then you could take a baby aspirin a day. But, because there could be a risk of gastrointestinal bleeding, talk to your doctor first about whether or not you’re a good candidate.

Q. If I cut down on smoking, do I have to quit?

A. Smoking just four cigarettes a day can raise your risk of heart disease. Even secondhand smoke can increase your risk. Quit!

Q. Can I drink in moderation?

A. If you don’t drink, don’t start. Recent studies do suggest, however, that in moderate doses—such as one to two drinks a day for a man and one drink a day for a woman—alcohol can actually protect your heart by raising good HDL cholesterol and reducing plaque. (One drink consists of a 12-ounce beer, 4 ounces of wine, 1.5 ounces of 80-proof spirits or 1 ounce of 100-proof spirits.) Having more than two drinks in half an hour or on an empty stomach, though, can raise your blood pressure and triglycerides, and contribute to stroke.

Q. Are women at a higher risk of heart disease after menopause? 

A. As women age, their risk of heart disease and stroke rises as they lose the protective benefit of natural estrogen. At 10 years after menopause (or about age 60), a woman has about the same heart attack risk as a 50-year-old man—depending on individual risk-factor profiles. After age 70, the risk of heart disease is the same for both sexes. So, after menopause, it is especially important to quit smoking, get regular physical exercise, maintain your weight and see your doctor for regular visits.

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