I am a snowbird who uses two different cardiologists for my health, and I am devoted to both of them. However, they have conflicting advice. I have coronary artery disease and had three stents placed in New York. I am an active 86-year-old woman who walks at least a mile daily and does light weights. My lab results are all normal. I take a daily baby aspirin and Plavix. I’ve done well with them. My Florida doctor wants me to discontinue the Plavix and take just the aspirin, but my New York doctor thinks I should keep the Plavix forever. I honestly don’t know the right course of action.

Both aspirin and Plavix (clopidogrel) work by decreasing the activity of platelets, the specialized blood cells that start to form clots. They have been shown to reduce blockages of stents, which hold open blood vessels that have been unblocked via a catheter in the heart.

There are several different types of stents, and some of them have medications embedded in them, which release slowly over many months. These “drug-eluting” stents require using both aspirin and clopidogrel for a longer period of time.

There is some debate about how long to continue these medications, but I have not read any recommendations to continue them for more than 30 months.

A study — the DAPT trial — used exact information about the person and the type of stent to make predictions about balancing risks, and the results of the study showed that in your case, using both aspirin and clopidogrel would reduce heart attack risk slightly, but at an increased risk of bleeding. Nonetheless, some cardiologists will continue both medications in some patients if there are no problems.

It sounds like your New York cardiologist may have more knowledge about the stent, as it was performed in New York, so I would try to get the two of them to reach a consensus. There may be something about your particular case that warrants long-term treatment with these medications.

A few years ago, Johns Hopkins produced an article stating that possibly being hard of hearing and doing nothing about it could lead to Alzheimer’s disease. Is that study still valid?

It’s been almost 30 years since a link between hearing loss and dementia was first published, and recent research has confirmed this link. It now seems clear that hearing loss increases the rate of decline in brain function by 30% to 40%, independent of other risk factors.

Put another way, people with mild hearing loss had double the risk of dementia in 10 years; those with moderate hearing loss, triple the risk; those with severe hearing loss had five times the risk of dementia compared with people of normal hearing and the same age.

The brains of people with hearing loss are more likely to atrophy, as well. Of course, not everybody with hearing loss develops dementia, and people with normal hearing can.

There is some, but not conclusive, evidence that hearing aids protect the brain from dementia in people with hearing loss. However, it is clear that hearing aids can improve social functioning, well-being and some measures of memory. Despite this evidence, many older people with hearing loss do not get it treated.

Dr. Keith Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. © 2019 North America Synd., Inc.


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