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• The drug manufacturer Merck declined to provide unpublished safety data on its drugs, rofecoxib and etoricoxib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.

Acetaminophen Safety

Health Canada Reminds Canadians of Acetaminophen Risks

Health Canada issued an information update this week reminding Canadians of tighter dosage recommendations for acetaminophen (a.k.a. Tylenol; Tempra; paracetamol). Acetaminophen is used to counteract fever and pain and has been used safely for this purpose in many instances, however, overdosage can cause severe liver toxicity and death. 

What Makes Acetaminophen Toxic?

Diabetes Drug Increases Cardiovascular Risk

A Health Canada public advisory has been issued this week warning people with type 2 diabetes who are taking the drug, rosiglitazone, marketed as AVANDIA^®, AVANDAMET^® (contains both rosiglitazone and metformin), and AVANDARYL^® (contains both rosiglitazone and glimepiride) about the increased risk of adverse cardiovascular (heart-related) events associated with the use of this medication.  Rosiglitazone is a prescription drug  that is added to the treatment regime of people with type 2 diabetes whose blood sugar has not been controlled by a combination of dietary changes, exercise, and the oral hypoglycemic agent metformin.

Rosiglitazone can cause fluid retention in the body, which can aggravate some cardiac conditions and lead to swelling, weight gain, and worst of all, heart failure. The use of rosiglitazone may be associated with an increased risk of cardiac ischemia (poor blood supply to the heart).  AVANDIA^®/AVANDAMET^®/AVANDARYL^® are not recommended in patients with a history of ischemic heart disease. 

If you are currently taking rosiglitazone, contact your physician immediately to discuss your individual risk/benefit profile as well as other treatment options. Do not discontinue rosiglitazone therapy without  your physician's supervision. 

A PREVENTABLE EPIDEMIC

Type 2 diabetes is a chronic disease caused by obesity, sedentary lifestyles, and poor dietary choices. This is a lifestyle-induced epidemic, with 60,000 new cases diagnosed annually in this country (Health Canada 2005). Complications of chronic, poorly-controlled blood sugar include damage to small and large blood vessels leading to blindness, kidney failure, erectile dysfunction, ulcers and limb amputations, atherosclerosis, heart attacks and strokes. People with type 2 diabetes are also at increased risk of various types of infections. 

THE GOOD NEWS

From a health promotion perspective, Type 2 diabetes is both PREVENTABLE and MANAGEABLE with dietary and lifestyle change if these interventions occur early enough in the disease development process. Botanical medicine and specific nutrient therapy are also helpful in managing type 2 diabetes and preventing complications. 

For your individualized type 2 diabetes prevention or treatment plan, contact your naturopathic doctor. 

Naturopathic consultations are available at the Meridian Wellness Centre by calling 519-822-7075.

-Dr. Liz 

Weight-loss drug Sibutramine (Meridia) Withdrawn from Canadian Market

Citing serious cardiovascular risks that outweigh expected benefits, pharmaceutical manufacturer Abbott Laboratories voluntarily withdrew the prescription weight loss drug, sibutramine (known by brand names Meridia, Reductil, Reduxada and Ectiva) from the Canadian market this week.

Known History of Adverse Effects and Deaths with Sibutramine

That sibutramine is associated with serious cardiovascular adverse events and deaths is not news. Sibutramine was pulled from the market in Italy in 2002 (yes, that's eight years ago) after more than 50 adverse events, including 2 deaths and many other reports including tachycardia, hypertension and arrhythmias occurred in individuals taking the drug. In fact, hundreds of adverse reactions including 31 deaths associated with sibutramine had already been reported by 2002 from just within the UK, France, the U.S. and Canada (Wooltorton, CMAJ May 14, 2002;16(10)).

Sibutramine: Risks and Benefits

Used in conventional medicine to support weight loss in individuals with a body mass index (BMI) of 30 or higher, sibutramine is a sympathomimetic drug that increases heart rate and blood pressure via inhibition of reuptake of norepinephrine and serotonin in the central nervous system. Studies had demonstrated the drug to support 5%-8% weight loss with 6 months of use compared to 1%-4% with placebo (interesting results from the placebo - we can only speculate how the comparative effect of the drug would have measured up to an actual weight loss program of diet and lifestyle change..hmmm....). Providing 5%-8% weight loss, and only while individuals continued to take the drug, sibutramine offered an unfavourable risk-benefit profile. It was recognized to be a dangerous medication and was indicated as an adjunct to an overall weight loss program, i.e. an addition to a consistent program of diet, exercise and lifestyle modification (Wooltorton 2002).

Adjunctive or Primary Therapy?

Was sibutramine truly used as an adjunct to the counselling- and time-intensive practice of helping patients learn how to lose weight? Or did physicians and patients rely upon it as the ever-sought-after "magic pill" for weight loss while ignoring the role of unhealthy diet and lifestyle choices, hormonal imbalances, and mental-emotional factors contributing to obesity? After a decade of approved use in Canada, Health Canada never got around to protecting Canadians from the risks of taking sibutramine, so we have the manufacturer to thank for relieving doctors and patients of the opportunity to exchange a temporary and relatively small benefit for serious harm or death. Will we continue to risk our lives for the next "magic pill" and believe that we really don't need to take care of ourselves through healthy diets, exercise habits and attending to our mental-emotional needs?

No "Magic Pill" for Weight Loss; the power is within YOU

Achieving a healthy body mass is important to optimizing health and decreasing risks for many forms of disease and premature death. However, naturopathic physicians recognize that there is no "magic pill" for weight loss. Pharmaceutical and natural substances may be available (even Health Canada-approved!) to support weight loss, but should never considered to substitute for long-term healthy lifestyle practices. As a naturopathic physician bound by the oath of "First, do no harm", my view is that any substance, whether natural or pharmaceutical, that is used adjunctively to support weight loss (or any other health goal, in fact) must first and foremost be safe. Naturopathic doctors are experts in teaching the principles of healthy living and using evidence-based natural therapeutics to optimize health. This includes thorough assessment and coaching through safe, permanent weight loss, and education that empowers patients to optimize their health and self-care habits.

You CAN Start Improving Your Health Today

As a naturopathic doctor my goal is to provide comprehensive, minimally-invasive primary health care that is individualized to the unique needs of each person, equips them with the education to make healthful choices, and supports their innate capacity for self-healing. If safe and permanent weight loss is your goal, consult your naturopathic doctor or other primary health care practitioner to discuss your options and start improving your health today.

To find a naturopathic doctor near you, please visit www.oand.org and use the "Find an ND" function.