NSAIDs (Advil, Aleve, Vioxx...) increases risk of first heart attack

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Roman Bystrianyk - 26 Jun 2006 03:29 GMT

http://www.healthsentinel.com/org_news.php?event=org_news_print_list_item&id=097

"NSAIDs (Advil, Aleve, Vioxx...) increases risk of first heart attack",
Health Sentinel, June 26, 2006,

Nonsteroidal anti-inflammatory drugs, or NSAIDS, are assumed to be well
tolerated and are widely used as a therapy for common pain and
conditions such as arthritis. These pharmaceuticals constitute one of
the most widely used class of drugs, with more than 70 million
prescriptions and more than 30 billion over-the-counter tablets sold
annually in the United States alone. NSAIDs are called nonsteroidal
because they are not steroids. Steroids affect inflammation by
suppressing part of the immune system, which is the body's natural
healing response to trauma. Instead NSAIDs mainly inhibit the body's
ability to synthesize prostaglandins. Prostaglandins are a family of
hormone-like chemicals, some of which are made in response to cell
injury.

Unfortunately, prostaglandins are also involved in the healing
mechanism of the digestive system and because NSAIDs affect
prostaglandins they have the unwanted side effect of increasing the
possibility of gastrointestinal bleeding. According to the American
Journal of Medicine, "Conservative calculations estimate that
approximately 107,000 patients are hospitalized annually for
nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal
(GI) complications and at least 16,500 NSAID-related deaths occur each
year among arthritis patients alone. The figures of all NSAID users
would be overwhelming, yet the scope of this problem is generally
under-appreciated." These conservative figures are equivalent to 293
hospitalizations and 45 deaths each day from NSAID GI complications in
U.S. arthritis patients alone.

The New England Journal of Medicine also stated "If deaths from
gastrointestinal toxic effects from NSAIDs were tabulated separately in
the National Vital Statistics reports, these effects would constitute
the 15th most common cause of death in the United States. Yet these
toxic effects remain mainly a 'silent epidemic,' with many
physicians and most patients unaware of the magnitude of the problem.
Furthermore the mortality statistics do not include deaths ascribed to
the use of over-the-counter NSAIDS."

Still more shocking is that according to the Canadian Medical
Association Journal, "All NSAIDs, both COX-2 selective and
nonselective, provide only a modest symptomatic benefit over placebo,
and this benefit has been proven only in short-term trials. With
long-term therapy, it is not known whether the benefits of this class
of drugs exceed the harms." And although COX-2 selective NSAIDs were
developed on the theory of reduced patient problems the same study in
the Canadian Medical Association Journal, states, "COX-2 selective
NSAIDs do not necessarily reduce the incidence of complicated ulcers.
Second, the meta-analysis demonstrates that, rather than proving safer,
COX-2 selective NSAIDs cause more morbidity (total SAEs or Serious
Adverse Events) than nonselective NSAIDs."

In addition to now being found increasingly just how dangerous these
medications are and that they have been only slightly more beneficial
than sugar pill, a recent study in British Medical Journal (BMJ) notes
that, "as NSAIDs were originally developed for the relief of pain,
long term placebo controlled trials have not been done."

On top of the horrifying gastrointestinal problems it has become
increasingly clear that these medications also have serious
cardiovascular risks. In the recent documentary Prescription for
Disaster, we hear former Associate Director for Science and Medicine at
the Office of Drug Safety at the U.S. Food and Drug Administration
(FDA) turned whistle blower David J. Graham, MD, MPH testify before
Congress in November 2004 on the Vioxx disaster. "Vioxx is a profound
tragedy and a regulator failure. We're faced with maybe the single
greatest drug safety catastrophe in the history of this country. I
strongly believe this should have been and largely could have been
avoided, but it wasn't and over 100,000 Americans have paid dearly
for this failure. In my opinion the FDA has let the American people
down."

A May 2006 study in the European Heart Journal examines the
relationship between NSAID use and the risk of a heart attack. They
performed a large population based study on over 33,000 people who had
a first heart attack also termed Myocardial Infarction or MI for short.

The authors found "a clear but moderate association (less than
two-fold) between first MI and current use of NSAIDs." The
association between first heart attack and NSAID existed in
conventional, semi-selective, and COX-2 NSAIDs. The risk of first heart
attack varied widely with celecoxib (Celebrex ®) having the lowest at
an increased risk of 6% and etoricoxib (Arcoxia®) having a huge
increased risk of 121%. The risks for first heart attack were as
follows:

Conventional NSAIDs:

Indomethacin (Indocin®) - 56%
Ibuprofen (Advil®) - 41%
Diclofenac (Voltaren®) - 35%
Naproxen (Aleve®) - 19%
Piroxicam (Feldene®) - 35%
Ketoprofen (Orudis®, Oruvail®) - 11%
Tolfenamic Acid - 39%
Other conventional NSAIDs - 23%

Semi-selective NSAIDs:

Nimesulide - 69%
Etodolac (Lodine®) - 35%
Nabumetone (Relafen®) - 26%
Meloxicam (Mobic®) - 24%

COX-2 NSAIDs:

Etoricoxib (Arcoxia®) - 121%
Rofecoxib (Vioxx®) - 44%
Celecoxib (Celebrex®) - 6%
Multiple NSAIDs - 56%

The study also shows that even after stopping taking NSAIDs users still
have increased risk of heart attack for a month after stopping.
However, after a month the risk of first heart attack was decreased to
normal. "Our findings clearly indicate that the risk is reversible
and associated with the presence of the drug in the body; the closer
the proximity of the prescription, the larger the effect."

The authors conclude, "The present large population-based
case-control study demonstrated a modest association of MI with current
use of all NSAIDs."

In the case of NSAIDs we must carefully consider a class of medication
that does not have long term placebo controlled testing, is only
moderately better in symptom relief over placebo, conservatively causes
293 hospitalizations and 45 deaths each day from gastrointestinal
bleeding, and greatly increases the chance of having a heart attack.

SOURCE: European Heart Journal, May 2006; British Medical Journal
(BMJ), 2006; Canadian Medical Association Journal, November 2002;
American Journal of Medicine, July 1998; The New England Journal of
Medicine, June 1999; Documentary: Prescription for Disaster