Archive for April, 2015

Strokes Compounded With Aspirin Resistance

Persons who exhibit a resistance to aspirin may be more likely to have more severe, and larger, strokes than those who still respond to the drug, according to a new study.

“Eventually we may be able to identify people who are likely to be resistant to aspirin and give them higher doses or different drugs to prevent blood clots,” said lead author Mi Sun Oh, MD, of Hallym University College of Medicine in South Korea.

Prior aspirin use has been associated with lower stroke severity and decreased infarction size.

However, the effect of aspirin resistance on stroke severity has been inconclusive.

Doctors do not routinely test patients for aspirin resistance.

STUDY DETAILS

Dr. Oh and colleagues set out to evaluate the effect of aspirin resistance on initial stroke severity and infarct size measured by MRI diffusion weighted imaging (DWI) in 310 patients.

“We enrolled patients with at least 7 days of aspirin before symptom onset, evidence of ischemic stroke on DWI, and aspirin resistance checked within 24 hours of hospital admission,” he said.

A total of 86 patients (27.7%) were resistant to aspirin.

In a multivariable analysis, aspirin resistance was significantly associated with higher initial NIH Stroke Scale score.

Aspirin resistance also was a significant predictor of larger DWI infarction volumes.

The infarct size was 2.8 cc in aspirin-resistant patients compared with 1.6 cc for those who responded to aspirin.

In conclusion, Dr. Oh said: “Aspirin resistance is independently associated with increased initial stroke severity and stroke volume in acute ischemic patients.

However, we need better ways to identify people with aspirin resistance before any changes can be made.

DON’T STOP LOW-DOSE ASPIRIN YET

For now, people who are taking low-dose aspirin to prevent blood clotting and stroke should continue to do so.”

Antiplatelet agents such as aspirin reduce platelet aggregation, the formation of thrombus, and the size and frequency of thrombotic emboli.

When patients do not have adequate platelet inhibition, this may lead to larger and more severe strokes because of larger thrombus and higher rate of thrombotic emboli.

The researchers presented their results at the American Academy of Neurology’s 67th Annual Meeting in Washington, DC, April 18 to 25, 2015.

Abstract title: Aspirin Resistance is Associated with Increased Stroke Severity and Infarction Volume

Erectile, Sexual Function Better in Active Men

The more a man exercises, the better his erectile and sexual function, regardless of his race, according to a new study designed to define a minimum exercise threshold for best sexual function.

Many studies have highlighted the relationship between better erectile function and exercise, but black men have been underrepresented in the literature.

“This study is the first to link the benefits of exercise in relation to improved erectile and sexual function in a racially diverse group of patients,” said senior author Adriana Vidal, PhD, of the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute and Department of Surgery in Los Angeles.

This cross-sectional study included nearly 300 participants from a case-control study that assessed risk factors for prostate cancer conducted at the Durham Veterans Affairs Medical Center.

The men, about one-third of them black, self-reported their activity levels.

The researchers then stratified them into 4 exercise groups: sedentary, mildly active, moderately active, and highly active.

The subjects also self-reported their sexual function, including the ability to have erections and orgasms, the quality and frequency of erections, and overall sexual function.

MORE FREQUENT EXERCISE = HIGHER SEXUAL FUNCTION

A multivariate analysis showed that men who reported more frequent exercise, a total of 18 metabolic equivalents (METS) per week, had higher sexual function scores, regardless of race.

MET hours reflect both the total time of exercise and the intensity of exercise.

A score of 18 METS is the equivalent of 2 hours of strenuous exercise, such as running or swimming; 3.5 hours of moderate exercise; or 6 hours of light exercise.

“Higher exercise was associated with a better sexual function score.

Importantly, there was no interaction between black race and exercise, meaning more exercise was linked with better erectile/sexual function regardless of race,” the researchers stated.

In contrast, exercise at lower levels was not statistically or clinically associated with erectile or sexual function in men of any ethnicity.

Additional contributors to low sexual function included diabetes mellitus, older age, past or current smoking, and coronary artery disease.

LESS INTENSE EXERCISE BETTER THAN NONE

Study coauthor Stephen Freedland, MD, Director of the Center for Integrated Research in Cancer and Lifestyle in the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, cautions that exercise should be tailored for each person.

“When it comes to exercise, there is no one-size-fits-all approach,” said Dr Freedland, who also serves as codirector of the Cancer Genetics and Prevention Program.

“However, we are confident that even some degree of exercise, even if less intense, is better than no exercise at all.”

The researchers published their results online in the March 20, 2015 issue of Sexual Medicine.