What Should Patients Do
Doctors are already aware from previous studies that non-steroidal anti-inflammatory drugs could increase the risk of heart problems and strokes.
And current UK guidelines state that Nsaids must be used carefully in people with heart problems and in some cases they should not be used at all.
Dr Mike Knapton of the British Heart Foundation, suggests patients and doctors weigh up the risks and benefits of taking high doses of these common painkillers, particularly if they have survived a heart attack or are at higher risk.
Meanwhile, GP leader Prof Helen Stokes-Lampard said it was important that any decision to prescribe was based on a patient’s individual circumstances and medical history, and was regularly reviewed.
She said that as new research was published, it was important that it was taken on board to help inform guidelines.
But she added: “The use of Nsaids in general practice to treat patients with chronic pain is reducing, and some of the drugs in this study are no longer routinely prescribed in the UK, such as coxibs, as we know that long-term use can lead to serious side-effects for some patients.”
Answers Won’t Come Soon
Nissen and colleagues are conducting a clinical trial that he and Farkouh agree should answer the ibuprofen question once and for all. That trial, now enrolling 20,000 patients, will compare Celebrex, naproxen, and ibuprofen in patients at risk of heart disease.
In that trial, patients will take their aspirin two hours before taking their study medication.
The good news is the trial will, at last, provide sorely needed information on the relative heart risks of common pain relievers.
The bad news: The study won’t start returning results until 2010.
SOURCES: Farkouh, M.E. Annals of the Rheumatic Diseases, early onlineedition, downloaded April 3, 2007. Michael Farkouh, MD, MPH, director ofclinical trials, Mount Sinai Heart associate professor of medicine, MountSinai School of Medicine, New York. Steven Nissen, MD, chairman, department ofcardiovascular medicine, The Cleveland Clinic.
Aspirin For Heart Attack Prevention
Aspirin can help prevent heart attacks in people with coronary artery disease and in those who have a higher than average risk. Only low dose, usually just 1 a day, is needed. But people who think they may be having an attack need an extra 325 mg of aspirin, and they need it as quickly as possible. For the best results, chew a single full-sized 325-mg tablet, but dont use an enteric-coated tablet, which will act slowly even if chewed. And dont forget to call 911, then your doctor. Its a contemporary update on the old reminder to take two aspirin and call in the morning and its good advice to chew over.
Heart failure is manageable. To learn the mechanics of the heart, the symptoms and warning signs of heart failure, and, most of all, the keys to an effective treatment plan, buy the Harvard Special Health Report Heart Failure: Understanding the condition and optimizing treatment.
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Fda Strengthens Warning On Nsaids And Heart Risk
July 10, 2015 — Popular painkillers like ibuprofen and naproxen have carried warnings for years about potential risks of heart attacks and strokes. This week, the FDA decided to strengthen those warnings on the medications, known as nonsteroidal anti-inflammatory drugs, or NSAIDs.
The warning includes both prescription and over-the-counter versions of drugs. It emphasizes that the risk applies to even short-term use of medications like Advil, Aleve, and Motrin. And itâs true for people with or without heart disease.
WebMD turned to three experts to sort out the issues.
Why is the FDA requiring stronger warning labels?
After looking at new safety information on both forms of the drugs, the FDA determined that the risks are greater than originally believed. The risk of heart attack and stroke can happen even in the first few weeks of using the drugs. And that risk is greater the higher the dose. These worse odds apply to people with or without a history of heart disease, the FDA says.
“They are not ruling out risk on a short-term basis,” says Bill McCarberg, MD, a San Diego family physician who has published extensively on NSAIDs. The new warning, he says, “lets even occasional users know they are taking a risk.”
While some NSAIDs may be less risky, the agency says the information it has now is not enough to rate individual drugs by risk level.
How do NSAIDs boost the risk of heart attacks and strokes?
Is there any way to pick the ”safest” NSAID?
Nsaid Heart Attack Risk Apparent In First Week Of Use
Analysis of data from nearly 450,000 patients reveals that celecoxib, diclofenac, ibuprofen, naproxen and rofecoxib all increased heart attack risk, with the greater risk of heart attack becoming apparent in the first week of treatment.
NSAIDs
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Non-steroidal anti-inflammatory drugs can increase the risk of heart attack within the first week of use, according to results from a study of nearly 450,000 people.
Analysing data from 446,763 people in Canada and Europe, 61,460 of whom had a heart attack, researchers found that the greatest increase in risk of heart attack occurred in the first month of taking high doses of NSAIDs.
Reporting their results in the British Medical Journal , the Canadian researchers say that while the increased risk of a heart attack with NSAIDs has been shown in other studies, the effect of factors such as short-term or intermittent use, dosage and type of NSAID have not been understood previously.
The analysis, which included real-life data from several studies including one from the UK General Practice Research Database, found that celecoxib, diclofenac, ibuprofen, naproxen and rofecoxib all increased the risk of heart attack whether taken for one week, one month, or longer than a month, compared with not using these medications.
Compared with non-use, the associated increased risk of a heart attack when taking NSAIDs was 20%50%, rising to 75% for ibuprofen and naproxen and more than 100% for rofecoxib.
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Ibuprofen Can Triple Stroke Risk Painkillers Can Double Heart Attack Chances
Many of us commonly use painkillers to squelch the common headache or relieve back pains. However it has been found that even over the counter ibuprofen can increase stroke risk by three times and drugs such as rofecoxib and lumiracoxib can double the risk of heart attack. NSAIDs are commonly prescribed for the inflammation of arthritis and other body tissues, such as in tendinitis and bursitis.
Pain, fever, and inflammation are promoted by the release in the body of chemicals called prostaglandins. Ibuprofen, for example, blocks the enzyme that makes prostaglandins , resulting in lower levels of prostaglandins. As a consequence, inflammation, pain and fever are reduced.
A study published today by the British Medical Journal online examined the effect of include traditional non-steroidal anti-inflammatory drugs as well as new generation anti-inflammatory drugs, known as COX-2 inhibitors and risk associated with heart attack and stroke.
Doctors and patients need to be aware that prescription of any anti-inflammatory drug needs to take cardiovascular and stoke risks into serious consideration.
The Swiss authors of the study state:
Our study provides the best available evidence on the safety of this class of drugs. Although uncertainty remains, little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms. Cardiovascular risk needs to be taken into account when prescribing any non-steroidal anti-inflammatory drug.
Cv Risks Of Nsaids In Patients After Hospitalization For Serious Coronary Heart Disease
The question of CV safety is of particular importance for patients with existing serious coronary heart disease, as their baseline risk of CV events is increased., This retrospective cohort study examined 5 individual NSAIDs in 48,556 patients recently hospitalized for myocardial infarction , revascularization or unstable angina pectoris. The follow-up began 45 days postadmission, so results cannot be generalized to the early postdischarge period. The primary end point was serious coronary heart disease . Secondary end points were a composite of serious CV disease and death from any cause. For naproxen, the incidence rate ratio relative to nonusers of any NSAID was 0.88 for the primary end point and 0.91 for the secondary end points, which were both lower than the rates of the other NSAIDs studied. When duration of use was taken into account, an increased risk of serious coronary heart disease was associated with short-term use of ibuprofen , diclofenac , rofecoxib and celecoxib , unlike naproxen . Longer duration of use, however, did not result in a significant increase in CV risk. The most commonly prescribed dose of naproxen was 1000 mg/d or greater, and there was no evidence of increased CV risk at these higher doses.
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Studies Point To Inflammation
Two decades ago, researchers discovered that high levels of inflammation were associated with an increased chance of having a heart attack or stroke. However, what they didnt know was whether anti-inflammatory treatments could prevent those events from occurring.
In 2008, the JUPITER study found that for older adults who did not have elevated blood cholesterol but who did have elevated blood levels of inflammatory markers, treatment with cholesterol-lowering statin drugs reduced the number of heart attacks and strokes. But it wasnt clear whether that was because statins reduced inflammation or because they further lowered bad cholesterol, since they do both.
However, a recent clinical trial called CANTOS studied an injectable antibody type of anti-inflammatory drug in people who had a prior heart attack and who also had elevated inflammatory markers despite statin treatment. This landmark study finally proved that targeting inflammation without changing cholesterol levels can have a significant impact. People treated with the novel anti-inflammatory treatment reduced their likelihood of subsequent heart attacks or strokes by 15 percent. It also decreased the need for major interventions such as angioplasty and bypass surgery by 30 percent, proving that addressing inflammation to prevent heart disease is essential. Additional studies are now looking at whether older, cheaper medications taken by mouth can have similar heart protection benefits.
Ibuprofen May Cause Side Effects Tell Your Doctor If Any Of These Symptoms Are Severe Or Do Not Go Away:
- constipation
- confusion
- aggression
Ibuprofen may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .
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Risk Of Heart Failure
Non-steroidal anti-inflammatory drugs are associated with elevating blood pressure as well as sodium and fluid retention. Both of these effects may unmask previously undiagnosed heart failure, or worsen the symptoms in people known to already have heart failure.
Research published in the British Medical Journal in September 2016 studied 92,163 people admitted to hospital with heart failure, and found NSAID use in the two weeks prior to admission was associated with a 19% increased risk of hospital admission for heart failure. This was compared with people who had not used NSAIDs prior to admission.
The association of NSAIDs with an exacerbation of heart failure was also seen in many older studies. For example, an Australian study in 2000, suggested almost 20% of all heart failure related admissions to hospital may be attributed to recent NSAID use.
Ibuprofen Naproxen: No Heart Risk
Pain Relievers Don’t Increase Risk of Heart Attacks, Study Shows
Nov. 28, 2005 – Long-term use of two popular over-the-counter pain relievers does not appear to increase a person’s risk of having a heart attack, a study from the U.K. shows.
Researchers reported no increase in risk among people who took either ibuprofen or naproxen for a year or longer in moderate doses.
Ibuprofen and naproxen are among the best-selling nonsteroidal anti-inflammatory drugs . Ibuprofen-based pain relievers include Advil, Motrin, and Nuprin. Naproxen-based products include Aleve and Naprosyn.
A slight, but significant, increase in risk for nonfatal heart attacks was seen among people who took the prescription NSAID diclofenac, known by the brand name Voltaren, for more than a year. Voltaren is one of the most popular pain relievers in Europe, but it is not as widely prescribed in the U.S.
The findings suggest that when it comes to cardiovascular risk, not all NSAIDs are created equal, the study’s researcher tells WebMD.
“It appears that there is a small increase in risk for certain NSAIDs under certain circumstances,” says Luis A Garcia Rodriguez, MD. “But it is definitely not what we would call a major effect.”
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Answers Wont Come Soon
Nissen and colleagues are conducting a clinical trial that he and Farkouh agree should answer the ibuprofen question once and for all. That trial, now enrolling 20,000 patients, will compare Celebrex, naproxen, and ibuprofen in patients at risk of heart disease.
In that trial, patients will take their aspirin two hours before taking their study medication.
The good news is the trial will, at last, provide sorely needed information on the relative heart risks of common pain relievers.
The bad news: The study wont start returning results until 2010.
SOURCES: Farkouh, M.E. Annals of the Rheumatic Diseases, early onlineedition, downloaded April 3, 2007. Michael Farkouh, MD, MPH, director ofclinical trials, Mount Sinai Heart associate professor of medicine, MountSinai School of Medicine, New York. Steven Nissen, MD, chairman, department ofcardiovascular medicine, The Cleveland Clinic.
Natural Safe Alternatives To Nsaids
If youre going to use a pain-relieving drug, choose aspirin. It is the safest, although it can cause stomach bleeding. Its better to consider these natural, safe and effective alternatives:
- Turmeric reduces pain from muscle pulls and other injuries. A typical turmeric supplement dose is 400-600 mg.
- Willow bark contains salicin. This is the same compound in aspirin that relieves pain and inflammation. It treats headache, low back pain, menstrual cramps, fever, flu, tendonitis, bursitis, and osteoarthritis. Take 1-3 grams.
- Capsaicin is the compound in hot peppers that makes them spicy. It is applied as a topical treatment for arthritis pain.
- Bromelain is an extract of pineapple. It is effective in treating inflammation associated with rheumatoid arthritis. Take 250 mg twice daily.
- Magnesium can be extremely effective for migraines. A recommended dosage is 400-600 mg.
These natural products allow many people to throw away their NSAIDsand their worries about giving themselves a heart attack.
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Ibuprofen Can Raise Risk Of Heart Attack
Doctors have warned that the painkiller ibuprofen can raise the risk of having a heart attack.
A study by British researchers suggests regular use of the drug increases the chances of an attack by almost a quarter.
Other painkillers in the same family of anti- inflammatory drugs – used by millions of arthritis patients – are even more hazardous, raising the risk by up to 55 per cent, according to the study.
Researcher Professor Julia Hippisley-Cox, who is also a GP, said the findings meant there should be an investigation into the safety of all this group of painkillers.
Ibuprofen is one of the most popular over-the-counter painkillers available from pharmacists and supermarkets – with 46 tons sold here each year. Sales of Nurofen have risen 15 per cent in the past year.
Increasing risk
“We have identified an increasing risk, which rises with the dosage of ibuprofen and the time it is used,” said Professor Hippisley-Cox. “We want to see this study followed up.”
However, she did not recommend that people stop taking it.
The latest study was undertaken after concern raised last year over a range of anti-inflammatory drugs called Cox-2s used by 1.4 million Britons.
A safety review by European regulators found these painkillers were linked with an increased risk of heart disease and stroke, and those at high risk were advised not to take them.
The new generation of anti-inflammatory drugs Cox-2s was also linked to higher rates of firsttime heart attacks.
Cardiovascular Riskevidence From The Recent Literature
A literature search was performed in July 2011 using OVID MEDLINE, International Pharmaceutical Abstracts, Reactions Weekly, Cochrane Database of Systematic Reviews and an internal citation database of pharmacy journals to identify recent relevant studies and reviews examining the association of NSAIDs and CV risk. The following search terms were used: NSAIDs, cyclooxygenase 2 inhibitors, cardiovascular diseases, heart diseases, vascular diseases, myocardial infarction, adverse effect and adverse drug reaction. Studies solely examining NSAIDs not available on the Canadian market were not considered. Additional studies referenced in the original findings were further identified for review. Three systematic studies considered relevant by the reviewers, which examined multiple anti-inflammatory agents, were retrieved and are examined in detail.
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Ibuprofen Or Naproxen Vs Prexige
The study by Farkouh and colleagues enrolled 18,325 arthritis patients. Nearly 17% of these patients were at high risk of heart attack and stroke.
The trial compared ibuprofen or naproxen to a new pain drug sold as Prexige in the U.K. and Canada.
Prexige is a member of the stomach-friendly family of pain drugs called Cox-2 inhibitors. Celebrex is the only member of this drug class sold in the U.S. Another Cox-2 drug, Vioxx, was taken off the market after people taking the drug had a suspiciously high number of heart attacks.
All of the high-heart-risk patients in the Farkouh study should have been taking low-dose aspirin. Sixty percent of them did. These patients should have had fewer heart attacks, strokes, and heart deaths than those who did not take aspirin.
But if the patients took aspirin and also took high-dose ibuprofen, they were nine times more likely to have a heart attack than were patients who took aspirin and Prexige. Patients who took ibuprofen without taking aspirin were no more likely to have a heart attack than those who took Prexige.
Farkouh and Nissen say there is strong evidence that ibuprofen blocks the blood-clot-preventing effects of aspirin. Both agree that the drugs do not interact if a person takes aspirin two hours before taking ibuprofen. But Farkouh says this approach will not work in the real world.