Cardiovascular disease (CVD) continues to be the leading cause of death among men and women in the United States. Once thought to affect primarily men, the incidence of CVD continues to rise among women. Statistics from the American Heart Association (AHA) reveal that in 2007, an estimated 1.2 million individuals in the United States will have a first or recurrent coronary attack, and an estimated 452,000 of these individuals will die.1 CVD is the leading cause of death among women, accounting for an estimated 38% of all deaths,2 and it is responsible for more deaths among women than the next 5 leading causes of death combined, including all forms of cancer.3
Various studies have demonstrated that a daily aspirin regimen can reduce the risk of a nonfatal first heart attack by approximately 32% and may reduce the risk of death by up to 23% if administered when a heart attack is suspected and for 30 days thereafter.4,5
More than 50 million adults in the United States routinely take aspirin for long-term prevention of CVD, with daily doses ranging from 81 to 325 mg.6,7
Debate persists about the appropriate long-term daily dosage of aspirin for cardiovascular protection. In a report published in the May 9, 2007, issue of the Journal of the American Medical Association, researchers who reviewed 11 clinical trials concluded that there was no current clinical evidence to support that higher doses of aspirin were more effective than lower doses of 75 to 81 mg daily for cardiovascular protection.6,7
The AHA recommends that the use of aspirin be considered in patients who have had the following conditions, if aspirin is not contraindicated8:
In February 2007, the AHA updated its aspirin guidelines for preventing CVD in women.9,10 Although the 2004 guidelines did not recommend aspirin use in healthy women or those with low cardiovascular risks, the 2007 revisions recommend that routine use of aspirin may be considered in women aged 65 and older—regardless of cardiovascular risk status—if benefits outweigh the risks.9,10 The AHA also recommends increasing the upper dose of aspirin for women at high risk for developing CVD from 162 to 325 mg daily.9,10
A variety of low-dose aspirin products are currently on the market, including chewable tablets, enteric-coated tablets and caplets, as well as formulations for women that also contain calcium (Table).
Pharmacists are likely to encounter many patients seeking advice on aspirin regimens and preventive therapy, as well as proper selection of aspirin products. All patients should be advised to consult with their primary health care provider before starting an aspirin regimen—especially if they have preexisting medical conditions—to determine if any aspirin regimen is suitable for them.
Before recommending aspirin therapy, it is imperative for pharmacists to assess the patient's allergy history and concurrent medical and medication history to screen for possible contraindications and drug interactions. In addition, pharmacists should counsel patients thoroughly about the proper use of aspirin products, as well as inform them of potential adverse effects and the importance of routine monitoring with their primary health care provider.
Patients should be reminded that if they are having a dental or surgical procedure to always alert the health care provider that they are currently taking aspirin. Pharmacists also should use this opportunity to remind patients to contact their primary health care provider if they have any questions or concerns.
Finally, pharmacists can remind patients of nonpharmacologic measures that also may minimize their cardiovascular risks, such as maintaining a healthy weight, eating a balanced diet low in fat, adopting an exercise routine if appropriate, lowering cholesterol and blood pressure, if necessary, as well as quitting smoking. Pharmacists can direct patients to the various educational resources available that provide information about cardiovascular health and preventive care.
Urinary incontinence (UI) affects individuals of all ages. Although it becomes more common in older people, it is not a normal part of the aging process. UI can be the result of anatomic, physiologic, and pathologic factors affecting the urinary tract, as well as other external factors.1
For more information on urinary incontinence, visit the following Web sites:
It is estimated that more than 17 million individuals in the United States have some degree of UI, and 85% of these cases are women (Table 1).2 In addition, another 34 million individuals are affected by various degrees of overactive bladder.1 According to the National Association for Continence, an estimated 80% of UI cases can be cured or improved.3 More than 50% of individuals affected by bladder disorders rarely—if ever—discuss these issues with their primary health care provider because of embarrassment or denial, and the issues are left untreated.2
Some cases of UI may be transient and caused by the use of certain medications or by a urinary tract infection and can be reversed.4 Many UI cases can be chronic and long lasting, however, unless the individual seeks medical evaluation and treatment.4 Behavioral therapy, the use of pharmacologic agents, and surgery are the 3 main types of treatment for UI.2,5
Key Tips for Patients
Pharmacists are likely to receive inquiries about supplies for the management of UI; therefore, it is important for pharmacists to understand the condition and be prepared to counsel and assist patients and caregivers in the selection of absorbent products. Pharmacists should always encourage patients to seek advice from their primary health care provider prior to using any of these products. Pharmacists also can be key in identifying the various medications that may contribute to or cause UI, including angiotensin-converting enzyme inhibitors, alpha adrenergic blockers, antihistamines, calcium-channel blockers, diuretics, and antidepressants.1,8
A variety of absorbent products are available that include guards/shields, undergarments, and briefs to assist in the absorption of urine (Table 2). These products can be either disposable or reusable and are available in many sizes; they may help in providing a moisture barrier to protect clothes, bedding, and furniture, as well as minimize skin contact with urine.
Selection of these products is based upon various factors, such as the amount of urine that is typically leaked, the severity and type of UI, the patient?s functional status, the patient?s personal preference, ease of use, and cost, as well as the product?s ability to control odor.1,9
Products are designed to meet the individual needs of men and women and for overnight use. Pharmacists can help patients understand the many options available for both the treatment and management of UI that may enable them to improve their quality of life.