Fri, May-12-17, 04:56
To Good Health!
Plan: IF Fung/LC Westman/Primal
NSAIDs, more bad news.
From the People's Pharmacy:
People who are hurting are caught between the proverbial rock and a hard place. Whether they’re suffering from a bad back or arthritis, there aren’t many medications that are effective.
Now more bad news about ibuprofen, naproxen, celecoxib (Celebrex), meloxicam and other NSAIDs has millions worried. That’s because a new study confirms an increased risk for heart attacks.
The evidence has been building for years that NSAIDs are bad for the cardiovascular system. Epidemiological studies have suggested that such drugs increase the risk for heart attacks, strokes, congestive heart failure and death. Here is a link to an article we wrote several years ago documenting these problems.
Despite prior research many health professionals and patients were reluctant to accept the bad news about ibuprofen, celecoxib, diclofenac, meloxicam, naproxen or other NSAIDs. There have been concerns about the quality of the studies. Some experts characterized the data as “imprecise” or “inconclusive.”
Now, Canadian and European researchers have just published an important article in the BMJ (May 9, 2017). The results reaffirm the risks of NSAIDs.
What They Did:
After reviewing 82 studies for inclusion in this meta-analysis they settled on eight that met their high standards. Over 400,000 subjects were part of this analysis. There were over 61,000 heart attacks in this group. Before we translate what they found we want you to read their words for yourself:
“Through its inclusion and exclusion criteria and the definition of exposures, this meta-analysis of individual patient data (IPD) aimed to emulate the design of a large, pragmatic randomised trial comparing the main non-steroidal anti-inflammatory drugs (NSAIDs) used in the general population. By studying 61,460 myocardial infarction [heart attack] events in real world use of NSAIDs, we found that current use of a NSAID is associated with a significantly increased risk of acute myocardial infarction. This was observed for all traditional NSAIDs, including naproxen.”
Interpreting the Bad News About Ibuprofen & Other NSAIDS:
So, how bad was it? The researchers noted that “NSAIDs exhibited a rapid onset of risk for myocardial infarction in the first week of use.”
That challenges the thinking of many people who assumed that it would take months of daily use to trigger this effect. Doses of ibuprofen greater than 1200 mg per day demonstrated the risk between eight and 30 days. That is higher than the standard daily dose recommended on the label of drugs like Advil or Motrin IB. The directions for Advil Tablets read:
“adults and children 12 years and over: take 1 tablet every 4 to 6 hours while symptoms persist
“If pain or fever does not respond to 1 tablet, 2 tablets may be used.
“Do not exceed 6 tablets [1200 mg] in 24 hours, unless directed by a doctor.”
If someone were to take the maximal OTC ibuprofen dose he would be approaching the “high dose” considered a risk by the researchers. Many doctors prescribe substantially higher doses for people who have suffered an injury or are complaining about chronic pain.
Bad News About Ibuprofen Not Isolated:
The authors note that NSAIDs as a class appear to have negative cardiovascular consequences. (The exception is aspirin, which may reduce the risk for heart attacks.) The higher the dose the greater the danger.
The Risk in Relative Terms:
Here is what was uncovered in terms of relative risk for people who took different NSAIDs for a week or less:
Ibuprofen: a 48% increased risk of heart attack
Diclofenac (Voltaren): a 50% increased risk of heart attack
Naproxen (Aleve, diclofenac): a 53% increased risk of heart attack
Celecoxib (Celebrex): 24%
Absolute Risk vs. Relative Risk:
In fairness, it is important to note that relative risk is almost always a scary number. A 50% increase in the risk of heart attack seems huge. And yet the absolute risk of suffering a heart attack is actually quite small. That’s because relatively few people will experience a heart attack in the first place.
We understand the the distinction between absolute risk or absolute benefit can be confusing. The pharmaceutical industry has learned how to take advantage of this complexity. For example, the maker of Lipitor (atorvastatin) used to state that this cholesterol-lowering drug was valuable:
“In patients with multiple risk factors for heart disease, LIPITOR REDUCES RISK OF HEART ATTACK BY 36%*…”
That seems like an impressive number. Some people might assume that more than a third of patients on Lipitor could avoid a heart attack. But the asterisk in the ads told something quite different:
“That means in a large clinical study, 3 percent of patients taking a sugar pill or placebo had a heart attack compared to 2 percent of patients taking Lipitor.”
So there was roughly one fewer heart attack out of 100 people taking Lipitor. And yes, that was a 36% relative risk reduction.
The same thing is true about the absolute risk of experiencing a heart attack on ibuprofen or related NSAIDs. Even a 50% increased risk is still a relatively small absolute increased risk. Nevertheless, we do think this is a serious cardiovascular complication of NSAIDs.
Here is what the BMJ authors concluded:
“This patient level meta-analysis of acute myocardial infarction associated with NSAIDs involving 61 460 cases in 446 763 individuals is the largest investigation of its type, and its real world origin helps ensure that findings are broadly generalisable.
“In summary, compared with non-use of NSAIDs in the preceding year, we documented that current use of all studied NSAIDs, including naproxen, was associated with an increased risk of acute myocardial infarction…Given that the onset of risk of acute myocardial infarction occurred in the first week and appeared greatest in the first month of treatment with higher doses, prescribers should consider weighing the risks and benefits of NSAIDs before instituting treatment, particularly for higher doses.”
Other NSAID Side Effects:
Digestive tract upset, stomach pain, nausea, bleeding ulcers, perforated ulcers
Heart attack, stroke, cardiac arrest
Irregular heart rhythms (A-fib)
Fluid retention, Heart failure
High blood pressure
Dizziness, unsteadiness, spaciness
Kidney damage, liver damage,
Skin rash and other dermatological reactions
Ringing in the ears
Asthma, breathing problems, allergic reactions
Changes in vision
People Love NSAIDs:
People in pain want relief, even if NSAIDs are not all that great at providing it. There just aren’t very many other options. More at: https://www.peoplespharmacy.com/201...nd-other-nsaids
CBS News: http://www.cbsnews.com/news/nsaid-n...rt-attack-risk/
Was also on ABC news.
Last edited by JEY100 : Fri, May-12-17 at 10:35.