Reduce Inflammation And Clotting To Prevent Heart Attacks
Heart attacks and strokes cause 50 percent of the deaths in North America today, yet many people are not adopting the lifestyle changes needed to prevent the factors that cause them: inflammation and clotting. A new study from the University of Michigan shows how important inflammation is as a cause of heart attacks and strokes . In this study, when mice formed clots in their blood vessels, they also had a rise in blood levels of interleukin-1 beta, a cytokine molecule that causes inflammation. Giving the mice an enzyme called CD39, which blocks inflammation by markedly reducing interleukin-1 beta, reduced the size and number of clots that formed in their bodies. Blocking the anti-inflammatory CD39 increased the number and size of clots.
CD39 is an enzyme found on the surface of white blood cells and the inner lining of blood vessels that inhibits inflammation. It is produced by humans, but its use in humans has not yet been tested and it is not an available treatment at this time.
Reducing Inflammation with Lifestyle ChangesExercise: Exercising muscles help to control after-meal blood sugar rises that damage tissues to cause inflammation. An extensive review of studies shows that exercise can reduce inflammation even more than statins do :785793).
Treat Chronic Infections: Having any chronic infection turns on your immune system to cause inflammation :11111119), so identifying and treating chronic infections should be part of an anti-inflammatory lifestyle.
Should I Keep Taking Nsaids
When we prescribe a medication, we weigh the risks and benefits to the patient. If you have high blood pressure, an NSAID may make you retain fluid or affect your blood pressure control, in which case it might not be worth taking it to ease a minor ache or pain.However, if you have severe arthritis in your knee and cant get up to walk without medication, a small increased risk to your heart may be acceptable. Mobility and living free of pain play a big part in quality of life, so we want to preserve that. Im often OK with my patients taking NSAIDs if they dont have kidney problems or are otherwise in good health.When using an NSAID, keep these tips in mind:
- Check the labels to buy the lowest dose necessary, and dont go over the recommended dosage.
- Use the medication for the least amount of time needed.
- Talk with your physician if you are taking an NSAID for a prolonged period or if you have heart problems or are at increased risk for them.
What Are The Risks Of Cox
In a normal body, the levels of Cox-1 and Cox-2 enzymes are naturally in balance. When you block one but not the other, unexpected things can happen.
It turns out that the Cox-1 enzymes also help make a chemical that encourages blood clotting and tightens the arteries. Normally, these nasty effects are kept in check by another chemical called prostacyclin. But prostacyclin is made, in part, with the help of Cox-2 enzymes — the enzymes that drugs like Celebrex block.
Blocking only Cox-2 upsets the balance of these enzymes. Levels of prostacyclin go down, the influence of Cox-1 goes unchecked, and your risk of heart attacks and strokes goes up.
This is why Cox-2 inhibitors have been linked to an increased risk of heart attacks and strokes. The dangers were considered so high for the drug Vioxx that it was taken off the market. Bextra, another Cox-2 inhibitor, was also removed from the market partly because of the same risk.
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The Results: Significant Elevations In Risk
In total there were 61,460 cases and 385,303 controls. Between the four trials included, the populations differed significantly. This study found that there was a relative risk increase of 20-50% overall, with what appears to be a 75% increase in risk for ibuprofen and naproxen, and over a 100% risk increase for rofecoxib . The risk of heart attack appears to increase almost immediately . There was also a dose effect observed, with higher NSAID doses appearing to correlate with greater risk. Interestingly, risk didnt continue to increase beyond a month of therapy. That is, there appears to be greater risk of heart attack if an NSAID is used beyond one month. There were some small but modest differences between the NSAIDs studied. Notably, naproxen appears equally harmful to other NSAIDs, while celecoxib appears no more harmful than the other NSAIDs.
There have already been some criticisms raised in the rapid responses, which seems to focus on the apparently immediate onset of risk with NSAIDs, which some feel may be related to reverse causation, in that these patients may have been taking NSAIDs for the pain of a heart attack. It should also be noted that non-prescription use of NSAIDs is no considered in this paper, as that data was not available. Given the widespread use of non-prescription NSAIDs, its really not clear to what extent this may have influenced the findings.
How Much Should You Worry About Nsaids
NSAIDs present a small additional risk for most men, but given how much of these drugs people take, it can’t be ignored. It’s worth discussing with your doctor, but keep it in perspective. Smoking, being overweight, eating an unhealthy diet, and not exercising enough are still the 800-pound gorillas in the room. “There are a lot of things that cause heart disease that men need to worry about more than NSAIDs,” Dr. Ruff says.
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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.
Confirmation Of Nsaid Risk
All NSAIDs, including naproxen, were found to be associated with an increased risk of acute myocardial infarction. Risk of myocardial infarction with celecoxib was comparable to that of traditional NSAIDS and was lower than for rofecoxib. Risk was greatest during the first month of NSAID use and with higher doses.
Does this mean that taking a single dose on an NSAID could cause a heart attack? If you were at high enough risk, yes, probably. If youre at low risk, even short-term use could increase risk, however.
With use for one to seven days the probability of increased myocardial infarction risk was 92% for celecoxib, 97% for ibuprofen, and 99% for diclofenac, naproxen, and rofecoxib.
So, be careful with NSAIDs.
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Increase In Arterial Blood Pressure
NSAIDs can cause sodium and water retention, as well as reduce formation of the vasodilator prostacyclin in the vessel wall. The risk of increased blood pressure during treatment with NSAIDs has long been known. This side effect seems to be present in all NSAIDs except low dose ASA, although some NSAIDs appear to be safer than others . According to a meta-analysis by Johson, et al. , analgesics from the group of NSAIDs lead to an elevation in mean blood pressure by 5 mmHg, but in this study, the increase in blood pressure reached the level of statistical significance only in the subgroup with medically controlled hypertension.
The blood pressure increasing effect is present also in the case of selective COX-2 inhibitors. According to a meta-analysis by Chan, et al. , the risk of blood pressure increase is higher with coxibs than with non-selective NSAIDs . The same study highlighted the differences between various coxibs. Significant increases in blood pressure were found with rofecoxib and etoricoxib, while the effect of celecoxib on blood pressure appeared to be minimal.
Fda Strengthens Warning That Nsaids Increase Heart Attack And Stroke Risk
- By Gregory Curfman, MD, Assistant Professor of Medicine, Former Editor-in-Chief, Harvard Health Publishing
Back in 2005,;the FDA warned;that taking nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen increased the risk of having a heart attack or stroke. In July 2015the FDA;took the unusual step;of further strengthening this warning. This was done on the advice of an expert panel that reviewed additional information about NSAIDs and their risks. Because ibuprofen and naproxen are available over-the-counter and so widely used, its important to be aware of the ibuprofen warnings and naproxen warnings and to take steps to limit the risk.
Many people take NSAIDs to relieve mild to moderate pain. These medications may be particularly effective in conditions in which pain results primarily from inflammation, such as arthritis or athletic injury. While you can buy ibuprofen and naproxen on your own, doctors commonly write prescriptions for celecoxib , diclofenac and other NSAIDs. Aspirin is also an NSAID, but it does not pose a risk of heart attack or stroke. In fact, aspirin is commonly used to prevent heart attacks and strokes. So, it is not covered by this warning.
The FDA has noted the following ibuprofen warnings and naproxen warnings along with similar risks of other NSAIDs:
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What’s The Risk Of Nsaids
The link between NSAIDs and heart problems is well established. “We’ve always counseled our patientsespecially when they have a history of heart diseasethat these medications can increase their risk,” Dr. Ruff says. The latest FDA warning comes down to several key points:
- All non-aspirin NSAIDs appear to be associated with higher risk of heart problems. The risk is greatest in those with known heart disease or multiple risk factors for it.
- It’s not known for sure yet which, if any, of the various NSAIDs in use are more risky than others. However, in studies to date, naproxen has shown the smallest risk.
- The higher the NSAID dose you take, and the longer you take it, the greater the potential risk.
NSAID safety tips
When Science Communication Breaks Down People Panic
If youve been reading the news recently, you could be forgiven for thinking that ibuprofen is basically poison that is going to kill you with a heart attack. Scary headlines like Study links ibuprofen to heart problems and Ibuprofen Linked To Increased Risk Of Cardiac Arrest have popped up everywhere, and people keep asking me the question;
Should I stop taking ibuprofen?
Now thats a complex question. Short answer is always the same; go and talk to your doctor. Im an internet blogger, not your personal font of medical advice, unlike the person that you pay to take care of you.
But the more interesting question that I can answer is What should I do based on this new study?.
And the reason why its so interesting is because every article youve read has probably got the entire mess so completely wrong.
Cases Mostly In Males Under 30
Tom Shimabukuro, MD, MPH, MBA, the deputy director of the Immunization Safety Office at the CDC, said the agency has received reports of 1,226 cases of myocarditis, with 827 reported after dose two of either the Moderna or Pfizer vaccine.
Of those cases identified after second doses, 563 followed the Pfizer vaccine series. In total, that’s approximately 12.6 heart inflammation cases per million doses administered in the United States.
Among the 1,226 patients, 484 are younger than 29, and roughly two-thirds are men.
A major talking point through the ACIP meeting was that only Pfizer is approved for emergency use in the United States for teens ages 12 to 18. For this age-group, adenovirus-based vaccines, such as Johnson & Johnson, are not currently available.
Doran Fink, MD, PhD, deputy director-clinical, division of vaccines and related products applications at the Food and Drug Administration , said the agency would add warnings about the rare side effects on Moderna and Pfizer fact sheets. The CDC also said patients who develop heart inflammation after a first dose of mRNA should wait until their inflammation heals before getting a second dose, and should talk to their care providers.
Take Acetaminophen Instead Of Commonly Used Painkillers Such As Aspirin Ibuprofen Doctor Recommends
Commonly used anti-inflammatory painkillers may increase the risk of heart attacks when taken during a cold or flu, a new study suggests.
The study was based on data on nearly 10,000 patients with an average age of 73 who were;hospitalized for a heart attack, also called acute myocardial infarction, in Taiwan from 2005 to 2011.;
Previous studies have shown an increased risk for heart attacks during a respiratory infection, such as cold or influenza, as well as with use of certain anti-inflammatory pain relievers. But the interaction between the infections and class of painkillers wasn’t examined.
The non-steroidal anti-inflammatories or NSAIDS include Aspirin, naproxen , ibuprofen and arthritis medications such as celecoxib .
Use of NSAIDs during a respiratory infection was associated with a three-fold increased risk of heart attack, Yao-Chun Wen from National Taiwan University Hospital in Taipei and colleagues reported in;Thursday’s issue of the Journal of Infectious Diseases.
But people suffering from a cold or flu commonly reach for over-the-counter painkillers such as Aspirin or naproxen to relieve fever and aches.
The risk was higher when NSAIDS were given intravenously in the hospital.
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Expert Reaction To Study Looking At Nsaid Painkillers And Heart Attack Risk
A new observational study;published in the BMJ investigates the association between painkillers and myocardial infarction;risk.
Dr Mike Knapton, Associate Medical Director at the British Heart Foundation, said:
The authors of this study use data from Canadian and European individual patient databases and concerned themselves with 5 drugs celecoxib, the three main traditional NSAIDs , and rofecoxib.; This involved 450 000 individuals, of which 61 000 had a heart attack it is the largest investigation of its type.; They found an increased risk of acute myocardial infarction with taking NSAIDs.
We already know this from previous research i.e. an association between taking NSAIDs and small increase in risk of thrombotic events, such as stroke and heart attack.
What is new here is that this study shows that the risk of myocardial infarction associated with NSAID use increases immediately with exposure ; there was a relationship between increasing NSAID daily dose and risk of acute myocardial infarction; and a longer duration of treatment generally does not seem to be associated with greater probability of increased risk of myocardial infarction.
Prof. Stephen Evans, Professor of Pharmacoepidemiology, London School of Hygiene & Tropical Medicine, said:
Is this good quality research?
This is good quality observational research, though there are limitations.
Are the conclusions backed up by solid data?
What are the absolute risks?
None others received.
How Risky Is Over
Since ibuprofen is available without a prescription, you might be wondering how risky it is to take this OTC medication every once in a while. Remember, most of the studies discussed in this article looked at people taking between 1,200 mg and 2,400 mg of ibuprofen per day on a long-term basis.
These doses are mostly higher than the recommended maximum OTC dose of 1,200 mg daily. Manufacturers of OTC ibuprofen also instruct you only to use this medication for 10 days in a row. If you find you need to take OTC ibuprofen at higher doses or for longer than this, or if you have a history of heart problems, you should speak with your provider to discuss if this is the best option for you.
But if you dont have heart disease and only use lower doses of ibuprofen for a short period of time, this medication is considered a low-risk option for occasional pain or fever relief.
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Nsaids: How Dangerous Are They For Your Heart
- By Christian Ruff, MD, MPH, Contributor
Nonsteroidal anti-inflammatory drugs, commonly referred to as NSAIDs, are one of the most common medications used to treat pain and inflammation. Ibuprofen, naproxen, indomethacin, and other NSAIDs are effective across a variety of common conditions, from acute musculoskeletal pain to chronic arthritis. They work by blocking specific proteins, called COX enzymes. This results in the reduction of prostaglandins, which play a key role in pain and inflammation. There are two types of NSAIDs: nonselective NSAIDs and COX-2 selective NSAIDs .
There is a growing body of evidence that NSAIDs may increase the risk of harmful cardiovascular events including heart attack, stroke, heart failure, and atrial fibrillation. Given the widespread use of NSAIDs, these findings have generated significant concern among patients and healthcare providers. I am frequently asked by patients: is it safe to continue to take NSAIDs?