Arthritis Sufferers Beware of Heart Attack Risks! By Mrs Vera West

     First, the usual disclaimer that this is not medical advice but merely a journalistic review of medical literature, and anyone reading this should consult their medical practitioner. Indeed, this is one area where self-medication could literally kill you. People suffering from numerous maladies such as arthritis and joint injuries often load up on non-steroidal anti-inflammatory drugs (NSAIDS), such as Ibuprofen. However, these drugs come with a risk. Doctors usually advise that it is generally safe to take these drugs for short periods of time, such as maybe a week at most. However, there is medical evidence out there that people need to be aware of, and to present to their doctor for an opinion. If long term use of NSAIDs is needed perhaps one needs to see a specialist.

     The first concerning study is: “Non-Steroidal Anti-Inflammatory Drug Use is Associated with Increased Risk of Out-of-Hospital Cardiac Arrest: A Nationwide Case–Time–Control Study,” Kathrine B. Sondergaard, Peter Weeke, Mads Wissenberg, Anne-Marie Schjerning Olsen, Emil L. Fosbol, Freddy K. Lippert, Christian Torp-Pedersen, Gunnar H. Gislason, and Fredrik Folke, European Heart Journal: Cardiovascular Pharmacotherapy, vol. 3, 2017, pp. 100-107. The take home message is that even short-term use of NSAIDS, maybe even a few days, are associated with an increased risk of cardiovascular ill effects. Here is the technical abstract:

“Aims Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used and have been associated with increased cardiovascular risk. Nonetheless, it remains unknown whether use of NSAIDs is associated with out-of-hospital cardiac arrest (OHCA). ................................................................................................................................................................................................... Methods and results From the nationwide Danish Cardiac Arrest Registry, all persons with OHCA during 2001–10 were identified. NSAID use 30 days before OHCA was categorized as follows: diclofenac, naproxen, ibuprofen, rofecoxib, celecoxib, and other. Risk of OHCA associated with use of NSAIDs was analysed by conditional logistic regression in case–time–control models matching four controls on sex and age per case to account for variation in drug utilization over time. We identified 28 947 persons with OHCA of whom 3376 were treated with an NSAID up to 30 days before OHCA. Ibuprofen and diclofenac were the most commonly used NSAIDs and represented 51.0% and 21.8% of total NSAID use, respectively. Use of diclofenac (odds ratio [OR], 1.50 [95% confidence interval (CI) 1.23–1.82]) and ibuprofen [OR, 1.31 (95% CI 1.14–1.51)] was associated with a significantly increased risk of OHCA. Use of naproxen [OR, 1.29 (95% CI 0.77–2.16)], celecoxib [OR, 1.13 (95% CI 0.74–1.70)], and rofecoxib (OR, 1.28 [95% CI 0.74–1.70)] was not significantly associated with increased risk of OHCA; however, these groups were characterized by few events. ................................................................................................................................................................................................... Conclusion Use of non-selective NSAIDs was associated with an increased early risk of OHCA. The result was driven by an increased risk of OHCA in ibuprofen and diclofenac users.

Conclusion In a nationwide cohort of persons with OHCA, we found that short-term treatment with non-selective NSAIDs, particularly ibuprofen and diclofenac, was associated with an increased early risk of cardiac arrest. We found no association between cardiac arrest and use of the COX-2 selective inhibitors, rofecoxib and celecoxib, nor the non-selective NSAID naproxen. Our findings support the accumulating evidence of an unfavourable cardiovascular risk profile associated with use of the non-selective NSAIDs. This calls for special awareness in order to balance risks against benefits in treatment with NSAIDs.”

     The British Medical Journal also has a study of this issue by M. Bally (et al.), “Risk of Acute Myocardial Infarction with NSADS in Real World Use: Bayesian Meta-Analysis of Individual Patient Data,” BMJ 2017; 357 doi:  https://doi.org/10.1136/bmj.j1909  (Published 09 May 2017). Basically, all NSAIDS have an increased risk of acute myocardial infarction, meaning heart attacks. Again, here is the technical abstract:

“Abstract

Objective To characterise the determinants, time course, and risks of acute myocardial infarction associated with use of oral non-steroidal anti-inflammatory drugs (NSAIDs). Design Systematic review followed by a one stage Bayesian individual patient data meta-analysis. Data sources Studies from Canadian and European healthcare databases. Review methods Eligible studies were sourced from computerised drug prescription or medical databases, conducted in the general or an elderly population, documented acute myocardial infarction as specific outcome, studied selective cyclo-oxygenase-2 inhibitors (including rofecoxib) and traditional NSAIDs, compared risk of acute myocardial infarction in NSAID users with non-users, allowed for time dependent analyses, and minimised effects of confounding and misclassification bias. Exposure and outcomes Drug exposure was modelled as an indicator variable incorporating the specific NSAID, its recency, duration of use, and dose. The outcome measures were the summary adjusted odds ratios of first acute myocardial infarction after study entry for each category of NSAID use at index date (date of acute myocardial infarction for cases, matched date for controls) versus non-use in the preceding year and the posterior probability of acute myocardial infarction.

Results A cohort of 446?763 individuals including 61?460 with acute myocardial infarction was acquired. Taking any dose of NSAIDs for one week, one month, or more than a month was associated with an increased risk of myocardial infarction. With use for one to seven days the probability of increased myocardial infarction risk (posterior probability of odds ratio >1.0) was 92% for celecoxib, 97% for ibuprofen, and 99% for diclofenac, naproxen, and rofecoxib. The corresponding odds ratios (95% credible intervals) were 1.24 (0.91 to 1.82) for celecoxib, 1.48 (1.00 to 2.26) for ibuprofen, 1.50 (1.06 to 2.04) for diclofenac, 1.53 (1.07 to 2.33) for naproxen, and 1.58 (1.07 to 2.17) for rofecoxib. Greater risk of myocardial infarction was documented for higher dose of NSAIDs. With use for longer than one month, risks did not appear to exceed those associated with shorter durations. Conclusions All NSAIDs, including naproxen, were found to be associated with an increased risk of acute myocardial infarction. Risk of myocardial infarction with celecoxib was comparable to that of traditional NSAIDS and was lower than for rofecoxib. Risk was greatest during the first month of NSAID use and with higher doses.”

  https://www.healthline.com/health-news/how-your-cold-medicine-may-be-harming-your-heart

     As well, paracetamol and aspirin are not as safe as was once thought. Here are some references for this:
  https://ard.bmj.com/content/annrheumdis/75/3/552.full.pdf
  https://www.theguardian.com/lifeandstyle/2015/may/25/does-paracetamol-do-you-more-harm-than-good
  https://utswmed.org/medblog/aspirin-heart-disease/

     So, folks, there is a problem here for people with chronic pain, to find a safe way of taking the edge off of this so that at worse one can get to sleep. I am no doctor, and cannot offer any medical advice, but what I can offer is information that you need to think this one through. Good luck!

All Blog Posts Authorised by K. W. Grundy
13 Carsten Court, Happy Valley, SA.