Arthritis - High-dose painkillers increase heart attack risk

Author

High-dose painkillers increase heart attack risk

Roman Bystrianyk

2005-06-15, 11:49 am

Matias A. Loewy, "High-dose painkillers increase heart attack risk",
Reuters, June 14, 2005,
Link:
http://www.reuters.com/newsArticle....storyID=8790140

At high doses, both the older anti-inflammatory painkillers known as
NSAIDs and the newer COX-2 inhibitors (dubbed coxibs) modestly increase
the risk of heart attacks in patients with arthritis, investigators
report.

This means, they say, that painkillers should be chosen based on their
relative gastrointestinal and cardiovascular safety profiles, rather
than their class.

Dr. Gurkipal Singh and colleagues at the Stanford university School of
Medicine, California, looked at the risk of heart attack in more than
650,000 adults diagnosed with arthritis and treated with NSAIDs or
selective COX-2 inhibitors between January 1999 and June 2004.

The researchers found that many, but not all, NSAIDS increased the
probability of heart attacks: indomethacin by 71 percent, sulindac by
41 percent, and ibuprofen by 11 percent. Among the coxibs, rofecoxib
increased the risk by 32 percent and celecoxib by 9 percent.

The risk of heart attack appeared to be dose-dependent. For instance,
rofecoxib increased the risk from 16 percent at daily doses of 12.5
milligrams to 240 percent at daily doses over 50 milligrams.

"Doctors need to consider individual patient risks and concerns related
to the cardiovascular system, and other areas where NSAIDs are known to
have an impact, especially the stomach, liver and kidneys, and they
need to be vigilant about which patients they prescribe each type of
drug to," Dr. Singh told participants here at the annual European
Congress of Rheumatology, where the findings were presented.

"It's a remarkable finding," commented Dr. Eduardo Mysler, head of the
Investigation Medical Organization (in Buenos Aires) and former
professor at New York University.

"From now on we should consider that cardiovascular risk is an inherent
risk of most anti-inflammatory drugs, independently of being an NSAID
or a selective COX-2 inhibitor," he told Reuters Health.

Sharon Hope

2005-06-15, 11:49 am

Thank you for the important post. On the face of it there is vital
information.

Interesting, though, just when we are starting to hear that the
cholesterol-lowering is a red herring, and that statin effectiveness lies in
its not-entirely-understood anti-inflammatory properties, we now hear
anti-inflammatories increase heart risk. Is there a subtext here?

Or is it that there is still confusion and lots of data to sort out?

All the absolutes seem to have been tossed into the air and no one is sure
where they will fall.

"Roman Bystrianyk" <rbystrianyk@gmail.com> wrote in message
news:1118797897.491709.317360@g47g2000cwa.googlegroups.com...
> Matias A. Loewy, "High-dose painkillers increase heart attack risk",
> Reuters, June 14, 2005,
> Link:
> http://www.reuters.com/newsArticle....storyID=8790140
>
> At high doses, both the older anti-inflammatory painkillers known as
> NSAIDs and the newer COX-2 inhibitors (dubbed coxibs) modestly increase
> the risk of heart attacks in patients with arthritis, investigators
> report.
>
> This means, they say, that painkillers should be chosen based on their
> relative gastrointestinal and cardiovascular safety profiles, rather
> than their class.
>
> Dr. Gurkipal Singh and colleagues at the Stanford university School of
> Medicine, California, looked at the risk of heart attack in more than
> 650,000 adults diagnosed with arthritis and treated with NSAIDs or
> selective COX-2 inhibitors between January 1999 and June 2004.
>
> The researchers found that many, but not all, NSAIDS increased the
> probability of heart attacks: indomethacin by 71 percent, sulindac by
> 41 percent, and ibuprofen by 11 percent. Among the coxibs, rofecoxib
> increased the risk by 32 percent and celecoxib by 9 percent.
>
> The risk of heart attack appeared to be dose-dependent. For instance,
> rofecoxib increased the risk from 16 percent at daily doses of 12.5
> milligrams to 240 percent at daily doses over 50 milligrams.
>
> "Doctors need to consider individual patient risks and concerns related
> to the cardiovascular system, and other areas where NSAIDs are known to
> have an impact, especially the stomach, liver and kidneys, and they
> need to be vigilant about which patients they prescribe each type of
> drug to," Dr. Singh told participants here at the annual European
> Congress of Rheumatology, where the findings were presented.
>
> "It's a remarkable finding," commented Dr. Eduardo Mysler, head of the
> Investigation Medical Organization (in Buenos Aires) and former
> professor at New York University.
>
> "From now on we should consider that cardiovascular risk is an inherent
> risk of most anti-inflammatory drugs, independently of being an NSAID
> or a selective COX-2 inhibitor," he told Reuters Health.
>

Harvey R. Stone

2005-06-15, 11:49 am

"Sharon Hope" <shope@anet.net> wrote in message
news:UpudnbjfXt2fIzLfRVn-3Q@comcast.com...
> Thank you for the important post. On the face of it there is vital
> information.
>
> Interesting, though, just when we are starting to hear that the
> cholesterol-lowering is a red herring, and that statin effectiveness lies
> in its not-entirely-understood anti-inflammatory properties, we now hear
> anti-inflammatories increase heart risk. Is there a subtext here?
>
> Or is it that there is still confusion and lots of data to sort out?
>
> All the absolutes seem to have been tossed into the air and no one is sure
> where they will fall.
>

From what I have been able to put together in other words,,, IMO,,,,, If
you have a heart condition, it would not be a good idea to take NSAIDS.
One of the problems is people telling their RD,,, to hell with this, I want
my NSAID to control the pain of arthritis, I do not have a heart problem.
That puts the RD in kind of a rufffff spot and you might visualize the
lawyers rubbing their greedy hands together. It is a look at our world.

Harv

Roman Bystrianyk

2005-06-15, 11:49 am

This related information maybe of interest to you. Have a good day.

"In this study we found that recent use of NSAIDs by elderly patients
doubles the odds of being admitted to hospital with an episode of CHF
[Congestive Heart Failure]. The estimated relative risk for first
admission with heart failure, and the risk of this outcome was
increased substantially by NSAID use in those with a history of heart
disease. ... Assuming the association between use of NSAIDs and CHF is
unconfounded, the disease burden attributable to these drugs may be
large - approaching the levels of morbidity and mortality that we
have previously documented for serious upper gastrointestinal
complications of NSAID use in NSW [New South Wales]."

Page J. MBBS(Hons) and Henry D. MBchB, "Consumption of NSAIDs and the
Development of Congestive Heart Failure in Elderly Patients",
Archives of Internal Medicine, March 27, 2000, Vol. 160, pp. 777-784

"During periods of concomitant use of diuretics and NSAIDs, a 2-fold
increased risk of hospitalization for CHF [Congestive Heart Failure]
was found compared with periods of diuretic used only. Patients with a
history of heavy diuretic use showed an increased risk. This may lead
to the hypothesis that an existing condition of CHF that is being
treated with diuretics is challenged by the introduction of NSAIDs."

Heerdink E., PhD, Leufkens H., PhD, Herings R., PhD, Ottervanger J.,
MD, Stricker B., MD and Bakker A., MD, "NSAIDs Associated With
Increased Risk of Congestive Heart Failure in Elderly Patients Taking
Diuretics.", Achrives of Internal Medicine, May 25, 1998, Vol. 158,
pp.1108-1112

Jim Chinnis

2005-06-15, 5:46 pm

"Sharon Hope" <shope@anet.net> wrote in part:

>Or is it that there is still confusion and lots of data to sort out?

Inflammation is a very complex process, involving many different
things. A statin does not affect inflammation the way an NSAID
does.
--
Jim Chinnis Warrenton, Virginia, USA