Petey, I wish I could be so blas about these studies, but I find them alarming. I depend on my brain power for my career, and a decline would be devastating.

Even more concerning for me, I have no family...since my mother died. The thought of dementia with no family members to help me is terrifying.

I was my moms medical advocate, and had I not been there for her, she would have been neglected and mistreated. I was constantly there questioning her medication and care.

I find this very scary stuff, and quite frankly, resent how doctors are leading us down the garden path. This is NOT a benign condition as they lead us to believe.

And I wonder, having gotten afib at a younger age, will this mean more time for silent strokes? Will I be thinking I'm George Washington by the age of 60?

Petey, I always hesitate to give my opinion on anything that gives members and visitors here a black and white impression on treatment. I know too well that there are many gray areas and that the impact of this condition varies greatly from person to person, both mentally and physically. I'm not a medical professional and I try to mention that from time to time. I certainly don't want anyone to think otherwise, my perspective is just thatmine. Hopefully what is discussed here acts as a catalyst for research and discussion with reader's doctors.

Shanny, I apologize if my posting here brought you any additional stress or concern, that was not my intention. Marikay makes an extremely important point. Your doctor must feel that you are in the lowest risk category at this time so he/she believes aspirin is your safest approach. I'm getting the feeling on what I've been reading that the parameters of the "aspirin safe" zone are changing. It's important to keep in mind that aspirin carries a risk of bleeding as well (mainly digestive) so you should pay close attention to any signs. But, just because I was taking aspirin when I had the TIA does not mean that the fault lies with it. The fact is that I had gone well over a decade using aspirin and had no problems. TIA or stroke is not dependent on Afib for occurrence, many non-Afibbers have them. We just have be more vigilant, use more precaution and adjust treatment(s) as the condition progresses. There are MANY factors that are considered to evaluate risk. Choosing the proper form of anticoagulation is difficult for both doctor and patient because there are no 100% safe options. Certainly aspirin is far better than no anticoagulation.

I stated that I'm an advocate of prescription anticoagulation for all forms of Afib but that belief comes from my personal experience. As I mentioned above I chose aspirin early on because that was the medically-recommended approach for paroxysmal Afib patients with fairly short(minutes, hours and not days) and infrequent episodes with no underlying heart disease or other conditions that would add risk. I still believe that was the correct approach for me at that time and I did very well.

The trickiest part of this is the transition into more frequent and longer episodes and knowing when to switch to more aggressive anticoagulation. That's where I failed. My condition progressed but I allowed my fear of the drugs keep me from the correct interpretation of the risks at that stage. Fear had fogged my judgement and I paid for it.

The last thing I would want to do is steer someone away from a treatment option that was right for them. I would no more suggest that you avoid aspirin as an anticoagulant as I would steer you away from ablation just because I had a bad experience or poor results. No two people are alike and no two arrhythmias are alike so treatments have to be chosen accordingly with the help of a physician.

When we're young and invincible our decisions are rarely influenced by safety. As we get older, safe decisions become as elusive as feeling young.

Well, this study seems to confirm it. The younger you are with the onset of afib, the greater your chances of Alzheimer's and other forms of dementia.

http://www.heartrhythmjournal.com/article/S1547-5271(09)01375-7/abstract

Just one thought....the silent strokes mentioned were referred to as "silent cerebral ischemia" in the original post. It is one type of stroke and has several causes, including coronary artery disease, hypertension, a clot, etc. Ischemia is loss of oxygen to the cells. This could be from a clot, In a fib there may be insufficent blood being pumped to the brain. This could also be a cause of the lesions mentioned. This actually worries me more...an anticoagulant won't fix that.

2 points... this study came out in 2009... so it isn't like our doctors shouldn't know this info and it comes from the official journal of the Heart Rhythm Society. BTW, it looks like the younger group is less than 70.

To put the dementia thing in perspective, the absolute numbers need to be looked at:

"Age remains the strongest risk factor for dementia, particularly for AD.3 In a community-based study, the estimated annual incidence of AD was 0.6% for patients ages 65 to 69 years, 1.0% for those 70 to 74 years, 2.0% for those 75 to 79 years, 3.3% for those 80 to 84 years, and 8.4% for those 85 years and older."

It seems that exercise, mental stimulation, controlling blood pressure, eating well, reducing stress, no drinking or smoking, etc. would all reduce your risk.

Most everyone (actually, everyone as they get older) have risk factors for dementia. We just have one that we can't change (actually 2 if you factor in age).

An obese person, with high blood pressure, that drinks and smokes, doesn't exercise, has a bad diet, lives a stressful life, has a family history of stroke and dementia is much worse off.


petey

Steve: I hear you... of course, I'm not a doctor either... but I have read too many blogs where people weren't anticoagulated and have had TIAs or strokes. We can't second guess doctors... but I think patients should ask their doctors how these studies translate to hard numbers. Also, doctors should be clear as to why someone is on or not on anticoagulants. The whole aspirin debate is a hot button. Some doctors and protocols include aspirin and the consensus statement posted on stopafib.org says aspirin doesn't prevent afib strokes (but is useful for non-afib strokes )

I read that, not anticoagulated, 35% of afibbers will have a stroke IN THEIR LIFETIME, so 65% (that great majority) won't. Most strokes occur after age 80 I read (maybe older, I forget the exact age).

People getting anticoagulated are evaluated for bleed risk by their doctors. HASBLED is system to evaluate the risk.

Reminder: I am not a doctor. I just read a lot. I'm sure doctors are irritated when patients read the web, but you do have the right to ask questions. You are paying for the medical advice.

A thought: What woulsd you think if you printed out the study and showed it to your doctor and he said, "Wow! I never knew that! Thanks! What else have you got? BTW, your bill is overdue!"


petey

Great thought Marikay. Vasculitis is another possible cause for concern for blood flow reduction. My mother suffered from this, hers affected the blood vessels in her head. She suffered terrible dizzy spells and ended up on steroids for almost ten years which was her downfall. I wonder if the same lies ahead for me.

When the scans were reviewed from my TIA, two spots were visible. There was concern that one may be an aneurism so a CT angiogram was ordered. It turned out to be an identical mark as the other that was typical of a TIA. There's no way to determine if I had a double TIA or if one may have happened as a silent event at another time, maybe while sleeping.

Agree with you Petey. If staying in NSR 100% of the time (ablation) isn't an option, a heart healthy lifestyle and really good rate control and anticoagulation are going to be the most helpful.
I know several elderly (80s-90s) with a fib (persistant) who are very sharp mentally. Even though our risk may be increased, most people with a fib don't have strokes and dementia.