Wednesday, January 19, 2011

NSAIDs Increase Risk of Heart Attack, Stroke and Cardiovascular Death

Clear Cardiovascular Risk with NSAID (Non-Steroidal Anti-Inflammatory Drug) Use

A very large-scale meta-analysis published last week by the British Medical Journal (BMJ) confirmed that use of NSAIDs (non-steroidal anti-inflammatory drugs) increases risk of heart attack or stroke.

Incredibly, there has been an eerie media silence on this important study, so I thought I'd highlight some of the details.

Data from 31 high-quality, randomized controlled trials involving a total of 116,429 patients with 117,218 patient years of follow-up were covered in the analysis. The following drugs were analyzed in comparison to one another and to placebo:
  • ibuprofen (e.g. Advil; Motrin) 
  • celecoxib (e.g. Celebrex) 
  • rofecoxib
  • lumiracoxib 
  • etoricoxib 
  • diclofenac
  • naproxen (e.g. Anaprox; Aleve)

NSAIDs are among the most widely prescribed pharmaceuticals, accounting for an estimated 5% of physician visits in the U.S.  However, the following findings should be considered before prescribing or taking NSAIDs:

  • Ibuprofen, celecoxib, rofecoxib, and lumiracoxib were associated with increased risk of heart attack
  • All 7 NSAIDs were associated with increased risk of the triad of non-fatal heart attack, non-fatal stroke, and cardiovascular death, compared to placebo
  • All 7 NSAIDs were associated with increased risk of death by any cause, compared to placebo
  • All NSAIDs except naproxen showed evidence of increased risk of cardiovascular death
  • All 7 NSAIDs were associated with increased risk of stroke
  • The drug manufacturer Merck declined to provide unpublished safety data on its drugs, rofecoxib and etoricoxib
  • Nonspecific NSAIDs are no more safe than the "new generation NSAIDs", i.e. selective COX-2 inhibitors, which have previously become known for cardiovascular risk
  • All NSAIDs, even those not included in the meta-analysis, have been observed to increase risk of cardiovascular adverse effects

This meta-analysis strongly cautions us to consider whether the cardiovascular risk of NSAIDs  outweighs their clinical benefit in chronic musculoskeletal pain management.
What are the options?  In a recent posting I outlined safety concerns with acetaminophen (Tylenol; paracetamol), specifically with respect to liver toxicity, and acetaminophen tends to be less effective than NSAIDs for pain management. Opioids like morphine are very effective analgesics but come with high risk of adverse effects, including addictive potential.

Both conventional and naturopathic physicians abide by the principle of of primum non nocere (first, do no harm). As a naturopathic doctor I am also guided by the principle of tolle causam (remove the cause). My aim is to eliminate the cause of a health condition by understanding and addressing all possible contributing factors through safe, non-toxic, effective therapies. People living with painful conditions can often benefit from a naturopathic approach that encompasses effective symptom relief through management and removal of the underlying causes. If you have a chronic health condition involving long-term or frequent use of pain medications like NSAIDs and would like to learn more about safe and effective naturopathic options, feel free to contact me. Safe medicine is good medicine.

-Dr. Liz


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