(Press-News.org) Even short-term use of some painkillers could be dangerous for people who've had a heart attack, according to research published in Circulation: Journal of the American Heart Association.
Researchers analyzed the duration of prescription non-steroidal anti-inflammatory drugs (NSAIDs) treatment and cardiovascular risk in a nationwide Danish cohort of patients with prior heart attack. They found the use of NSAIDs was associated with a 45 percent increased risk of death or recurrent heart attack within as little as one week of treatment, and a 55 percent increased risk if treatment extended to three months.
The study was limited by its observational nature and the lack of clinical parameters, researchers said.
NSAIDs are commonly used by the general population and are associated with increased cardiovascular risk in people with heart disease or those at high risk.
In a 2007 statement, the American Heart Association advised physicians about the risks of NSAID use among heart patients and provided a stepped care approach. In addition, the statement advised extra caution for when NSAIDs might be used, noting that they should "be limited to patients for whom there are not appropriate alternatives, and then, only in the lowest dose and for the shortest duration necessary."
In the current study, researchers undertook the first time-to-event analysis of a nationwide group and investigated if the duration of prescription NSAID treatment influenced the cardiovascular risk among heart patients. Among 83,697 heart attack survivors (average age 68; 63 percent men), 42.3 percent had a least one prescription for an NSAID.
The most common NSAIDs prescribed were ibuprofen (23 percent) and diclofenac (13.4 percent). Selective COX-2 inhibitors — rofecoxib (4.7 percent) and celecoxib (4.8 percent) — were also used.
The non-selective NSAID diclofenac was associated with early onset risk similar to the selective COX-2 inhibitor rofecoxib.
All NSAIDs were associated with an increased risk of death or recurrent heart attack, with diclofenac having the highest risk (nearly three times).
"Overall, NSAID treatment was associated with a statistically significant increased risk of death," said Anne-Marie Schjerning Olsen, M.B., lead author of the study and research fellow at Copenhagen University in Hellerup, Denmark. "Our results indicate that there is no apparent safe therapeutic window for NSAIDs in patients with prior heart attack."
The NSAID naproxen was not associated with an increased risk of death or recurrent heart attack. However, previous studies found increased gastrointestinal bleeding with naproxen.
Olsen said "a very conservative approach to use NSAIDs in patients with prior heart attack is warranted.
"If NSAID therapy is necessary for patients with known heart attack, the doctors should choose an NSAID less selective for COX-2 and a minimum for the shortest period."
Low-dose ibuprofen was the only available over-the-counter NSAID available in Denmark and was only dispensed in limited quantities (100 tablets at a time). So over-the-counter use of NSAIDs was unlikely to have had a major effect on the study results, researchers said.
In some countries, diclofenac is available as an over-the-counter drug without warnings about potential side effects. Recently, the U.S. Food and Drug Administration issued a warning that diclofenac should not be used by patients recovering from heart surgery.
But "the accumulating evidence suggests that we must limit NSAID use to the absolute minimum in patients with established cardiovascular disease," researchers said. Further study is warranted to establish the cardiovascular safety of NSAIDs, they said.
"The American Heart Association applauds this research that adds to our knowledge about the adverse effects of NSAID use in patients with coronary artery disease," said Elliott Antman, M.D., lead author 2007 NSAIDs advisory. "The authors further confirm our prior practical advice that NSAID use should be avoided and if unavoidable should be used at the smallest doses for the shortest time possible. Naproxen has not been shown to have an increased cardiovascular risk and may be safer than other NSAIDs."
INFORMATION:
Antman is a professor of medicine at Brigham and Women's Hospital and Harvard Medical School in Boston.
Co-authors are: Emil L. Fosbøl, M.D., Ph.D.; Jesper Lindhardsen, M.D.; Fredrik Folke, M.D., Ph.D.; Mette Charlot, M.D.; Christian Selmer, M.D.; Morten Lamberts, M.D.; Jonas Bjerring Olesen, M.B.; Lars Køber, M.D., D.MSc.; Peter R. Hansen, M.D., Ph.D., D.MSc.; Christian Torp-Pedersen, M.D., D.MSc.; and Gunnar H. Gislason, M.D., Ph.D. Author disclosures are on the manuscript.
Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association's policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding.
NR11 – 1075 (Circ/Olsen)
END
Overall, roughly half of U.S. children taken to hospital emergency departments (EDs) for a head injury receive a head CT scan, often to ease worried parents' concerns. Yet true traumatic brain injury is uncommon. A multi-center study of more than 40,000 children with minor blunt head trauma, led by Children's Hospital Boston and UC Davis, shows that allowing a period of observation can reduce the use of head CT by as much as half without compromising care – and without exposing children to ionizing radiation. Results appear in the June 2011 issue of Pediatrics (published ...
Despite the fact that silver has made less than optimistic headlines over the last few days, analysts predict that, in the medium to long term, the metal will continue to rise in value. Silver trading has been volatile recently, but the underlying economic and political conditions, that have supported its meteoric rise, remain unchanged. Debt issues in the US and many European countries have not disappeared, and the US dollar remains weak, following a brief rebound in the wake of the news of Bin Laden's death. Inflation fears also remain high, indicating continued support ...
Older, sicker heart-transplant recipients are significantly more likely to be alive a year after their operations if they have their transplants at hospitals that do a large number of them annually new Johns Hopkins research suggests. These patients fare less well at low-volume centers, the research shows.
The findings, to be presented May 9 at the American Association of Thoracic Surgeons' annual meeting in Philadelphia, add more support to the notion that patients do better when treated at medical centers that handle a higher number of cases similar to theirs.
"There's ...
WASHINGTON, D.C., May 9, 2011 – Unrealistic and uninformed media portrayals of weight not only can negatively influence individual behavior, but can impact how policymakers approach issues of weight and health. The result, according to experts from the Strategies to Overcome and Prevent (STOP) Obesity Alliance and the National Eating Disorders Association (NEDA), is a continued belief that these issues are largely a matter of personal responsibility and that little can or should be done in policy to address them.
Susan Dentzer, editor of Health Affairs, moderated a panel ...
Joe Altman, president of Altmans Winnebago, announced today that the Altman family has made the difficult decision to wind down their dealership operations beginning today, May 6, 2010.
In 1971, Altmans opened its doors in Baldwin Park, California and grew to become a trusted fixture within the RV industry.
"Our family has experienced 40 years of great and challenging times," notes Altman, "but current market conditions suggest it's time to end this chapter of our business."
Over the next month or so, Altmans will be liquidating the remaining ...
Los Angeles, CA (APRIL XX, 2011) Despite contrary belief, reducing unemployment in locations with active insurgencies does not decrease the rate of insurgent attacks against government and allied forces. Additionally, it was found that unemployment in these same locations also had no impact in reducing the deaths of civilians.
A new study released in the recent issue of the Journal of Conflict Resolution (published by SAGE) found that there is no correlation that aiding countries with high rates of unemployed young men leads to a decrease in political violence. Additionally, ...
New Haven, Conn. —Autism spectrum disorders (ASD) in South Korea affect an estimated 2.64% of the population of school-age children, equivalent to 1 in 38 children, according to the first comprehensive study of autism prevalence using a total population sample. The study—conducted by Young-Shin Kim, M.D., of the Yale Child Study Center and her colleagues in the U.S., Korea and Canada—identifies children not yet diagnosed and has the potential to increase autism spectrum disorder prevalence estimates worldwide.
ASDs are complex neurobiological disorders that inhibit a ...
ASG Dine, a leading distributor of strategic risk management and employee benefits solutions for the restaurant and food service industries, has announced an exclusive partnership with Walmart to offer discounted prescription pharmaceuticals to our customers and corporate partners.
The program provides a company's employees with access to more than 300 different prescription pharmaceuticals for just $4/prescription with a 30-day supply, and only $10/prescription with a 90-day supply. Prescription drugs that are currently not included in the program will still maintain ...
In the first large trial of its kind in the United States, researchers have shown that estrogen-lowering drugs can shrink tumors and reduce mastectomy rates for patients with stage 2 or 3 breast cancer.
Patients with these larger breast tumors have two options, says Matthew J. Ellis, MD, PhD, of Washington University School of Medicine in St. Louis and principal investigator of the trial conducted by the American College of Surgeons Oncology Group. "One option is to undergo mastectomy. The second is to receive medication before surgery to reduce the size of the tumor ...
215 Racing Inc. an American Based company, is proud to announce the exclusive rights to build the Lamborghini Indomable Concept created by Design 4 Motion. This design was created by Daniel Chinchilla under the Masters Program sponsored by Lamborghini. The design is a perfect fit for the first offering of 215 to the supercar market.
The car will be built by the Sub-company MOSTRO DI-POTENZA and will be renamed The SF22. This name comes from the design influence of the F22 fighter jet, and is incorporated in the car. SF stands for Street Fighter and only 50 of these cars ...
