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Health August 2013

Aid for Age

NSAIDS May Turn ‘Relief’ into ‘Risk’

By Tait Trussell

A new analysis that included 600 trials and case histories of more than 350,000 patients found that those who dosed on NSAIDS regularly increased their risk of heart attacks or stroke by as much a third.

The National Institutes of Health says chronic pain is increasingly common among the elderly — as if we weren’t aware of it.

So, for relief, we pop down Aleve or Advil or their generics: naproxen and ibuprofen, respectively to get some temporary relief. These are called nonsteroidal anti-inflammatory drugs, or NSAIDS. They work.

But a new analysis that included 600 trials and case histories of more than 350,000 patients found that those who dosed on NSAIDS regularly increased their risk of heart attacks or stroke by as much as a third.

According to recent studies presented at the European League Against Rheumatism, these basic pain relievers — NSAIDS — can be dangerous for patients with rheumatic diseases such as osteoarthritis, rheumatoid arthritis, and lupus. About 27 million Americans have osteoarthritis (OA), the "wear-and-tear" arthritis – and even more are likely to get it, given the number of individuals who are approaching senior status.

One of the studies found that one in eight patients are at risk of developing serious adverse drug event (ADE) is taking NSAIDS bought over the counter to treat a musculoskeletal problem.

A representative of the Alliance for Rational Use of NSAIDS, Jennifer Wagner, executive director of the Western Pain Society, advises talking with your health care provider about NSAIDS and the safest way to treat your pain.

Occasional use of NSAIDS probably won’t cause cardiovascular problems. It’s taking high doses of NSAIDS over a period of time that could create cardiovascular trouble.

Dr. Marie Griffin, a Vanderbilt University Medical Center preventative medicine specialist, said, “There aren’t really good choices.” She was quoted in The New York Times as saying NSAIDS often don’t really solve a chronic pain problem.

“If these drugs are making your life a lot better, that may be worth the risks,” she added. “But a lot of people will tell you, “I can’t tell if they’re doing anything. I just take them every day anyway.” NSAIDS include ibuprofen, with the brand named Motrin and Advil, naproxen, sold as Aleve, Naprosyn, Anaprox and Naprelan, and celecoxib, sold as Celebrex and available only by prescription.

Plain old aspirin also is a NSAID. But it’s used mainly in low doses to prevent heart disease. It was not included in the analysis.

NSAIDS were first seen as cardiovascular risks more than 10 years ago. That’s when drugs such as Bextra, Celebrex, and Vioxx were found to be risky for strokes and heart attacks. Merck took Vioxx off the market. Pfizer withdrew Bextra.

Dr. Garret A. Fitzgerald, director of the Institute for Translational Medicine and Therapeutics at University of Pennsylvania, said that evidence has been accumulating that nearly all NSAIDS pose some risk in heavy users.

Celebrex accounts for three heart attacks a year on average — one of them fatal among 1,000 patients taking high doses on a regular basis. Ibuprofen in daily doses of 2,400 milligrams also significantly raised the risk of heart attack.

The safest pain drug seems to be naproxen, even in high daily does. It doesn’t increase cardiovascular risk and may even have a protective effect similar to aspirin. But it does cause gastrointestinal problems.

All NSAIDS, including naproxen – which may guard against heart attacks — increase the risk of heart failure, the experts warn.

Dr. Brian Walitt, associate professor at Georgetown University, commented “People get very worked up about the cardiac risks…But these are population-wide risks, people are using these drugs for arthritis pain every day, “and most of them never have a problem.”

The experts’ advice boils down to this: For those who can’t function without the daily use of NSAIDS, use the lowest dose you can for the least amount of time. If you have heart disease or risk factors for it, have your doctor assess the risk of chronic NSAID use.

 

Tait Trussell is an old guy and fourth-generation professional journalist who writes extensively about aging issues among a myriad of diverse topics.

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