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• The drug manufacturer Merck declined to provide unpublished safety data on its drugs, rofecoxib and etoricoxib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

"Work Life Balance is an Ongoing Battle" - Nigel Marsh

This is a great 10-minute talk by Nigel Marsh on work-life balance and taking on the role and responsibility of choosing the right work-life balance for ourselves and our families. 

Enjoy!

-Dr. Liz

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?

Have a Healthy January

Happy and healthy new year!

January is an inspiring month for getting healthier and making plans to stay that way throughout the year. Already we notice the days getting a little longer, and here in Guelph the continuous cold keeps the pretty snow on the ground and our favourite winter activities accessible.

4 Ways to Stay Healthy in January

1. Humidify. Cold outdoor air holds little moisture, and indoor heated air holds even less. This means that if we don't add extra humidity to our indoor air, our protective mucus membranes (the inner linings of our nostrils, mouth, throat and respiratory passages) can dry out and become susceptible to infection. Ensure your furnace's humidifier is in good working order and keep a humidifier running in your bedroom at night. A few drops of your favourite essential oil added to the humidifier water can make this into a bedtime treat. Try 5 drops of lavender for sweet dreams or eucalyptus as a decongestant.

2. Nourish. January weather inspires warm and nourishing meal planning. In the heart of winter, choose the easily-absorbable nutrients of soups and stews over raw foods (which can take energy away from the body as it tries to break them down). Try your green leafies lightly steamed, your root vegetables roasted, and beans, lentils or poultry simmered and stewed. Add herbs to liquid cooking methods for boosts of flavour and antioxidants. Ginger, garlic and onions are tasty additions that also help you fight of viral infections like common colds and influenza. Think "slow food" and take the time to sit, savour and your meals.  

Homeopathy is Good Medicine

CBC to Critique Homeopathy?

Tonight, CBC Marketplace is set to air "Cure or Con", an apparent investigative journalistic piece that, based on its trailer, aims to discredit homeopathy. This isn't the first - and is unlikely to be the last - media attack on homeopathy, one of the world's most effective, safe and affordable systems of medicine. Trying to make the argument - in 2011 - that homeopathy isn't scientific or evidence-based only reflects ignorance of the massive body of evidence in support of homeopathy. In fact, there is so much evidence, it would probably take one's entire career just to skim over the titles.

Veggnog!

Eggnog Made Healthy

Want to know how to convert the classic yet rich and sugary eggnog into a healthy holiday treat?  Check out Veggnog (Vegan Eggnog) brought to you by the Healthy Hotties, a group of Toronto-based holistic nutritionists. Brilliant!

Sharks: Why They're Not Health Products

Alternatives to Shark Oil

Shark liver oil has been used for centuries by fishermen as a general tonic and folk remedy. Shark oils do contain many of the beneficial compounds that are also found in cold water fish, such as omega-3 fatty acids, vitamins A and D, which are important for optimal immune function. However, I do not consider shark oils to be appropriate substances for use in a health context.  As a naturopathic doctor I have never, and never will, recommend the intake of shark products to any of my patients. The risks are simply too great.

Why take such a stand on the shark-as-medicine issue? The naturopathic doctor's oath includes to "First, do no harm" and to "preserve the health of our planet for ourselves and future generations".  This means that the medicines I prescribe must be ecologically friendly.  Many of the world's sharks have come under survival pressures due to human activities - from intense demand for their fins for shark fin soup, or their cartilage for the mythological anti-cancer effects, to tragic bycatch losses whereby sharks are unintentionally caught in nets set for other species like tuna (a whole other issue), to spills and disasters, shark populations are particularly vulnerable to human follies because their slow rates of growth and reproduction and predator status makes them fewer in numbers relative to the "prey" species. Sharks are needed as predators to keep prey species healthy. Incidentally, dozens of "prey" species are also eaten by humans, so in helping sharks we would be helping ourselves maintain access to sustainable, healthy fish stocks (J. Sabau, Wake Shark & Ocean Educator 2009). A World Fishing & Aquaculture article published today noted that one third of Europe's shark species are currently considered threatened and the European Parliament has called for stronger policies against shark fin-removal on board ships.

Medicinal Properties of Shark Products Available From Alternative, Less Toxic Sources