NSAID’s in the News (again)

Medication - Over the Counter - otcLet me start by saying, that despite spending the last 20-something years in or around the pharmaceutical industry, I don’t like taking pills. That said, I’m not particularly partial to pain either. So when my knees or back hurts or I’m doubled over with dysmenorrhea, like many other people, I’ll reach for the ibuprofen.

But that may be about to change. Results from a new, large international study of non-steroidal anti-inflammatory drugs (NSAIDs), showed that high doses of them increase the risk of a major vascular event such as heart attack, stroke or death from cardiovascular disease by around a third.

In other words, for every 1,000 people with an average risk of heart disease who take high-dose ibuprofen for a year, about three extra would have an avoidable heart attack, of which one would be fatal, the researchers said.

vioxxThis puts the heart risks of generic NSAIDs on a par with Vioxx – the painkiller that U.S. drugmaker Merck famously pulled from sale in 2004 because of links to heart risks.

The study team from Oxford University in the UK, gathered data, including on admissions to hospital, for cardiovascular or gastrointestinal disease, from all randomized trials that have previously tested NSAIDs.

This allowed them to pool results from 639 trials involving more than 300,000 people and re-analyze the data to establish the risks of NSAIDs in certain types of patients.

In contrast to the findings on ibuprofen and diclofenac, the study found that high doses of naproxen, another NSAID, did not appear to increase the risk of heart attacks. The researchers said this may be because naproxen also has protective effects that balance out any extra heart risks.

Researcher, Colin Baigent stressed that the risks are mainly relevant to people who suffer chronic pain, such as patients with arthritis who need to take high doses of for long periods. “A short course of lower dose tablets purchased without a prescription, for example, for a muscle sprain, is not likely to be hazardous,” he said.

He also warns patients not to make hasty decisions or change their treatment without consulting a doctor.

For many arthritis patients, NSAIDs reduce joint pain and swelling effectively and help them to enjoy a reasonable quality of life,” he said. “We really must be careful about the way we present the risks of these drugs. They do have risks, but they also have benefits, and patients should be presented with all those bits of information and allowed to make choices for themselves.”

Donald Singer, a professor of clinical pharmacology and therapeutics at Warwick University, who was not involved in the study, said its findings “underscore a key point for patients and prescribers: powerful drugs may have serious harmful effects.

In the meantime, I for one, will be revising my pain versus pill-popping habit, or switching to naproxen.

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Fend off a 2nd Heart Attack with Fruit and Fiber

Pills_from_MDEach year, at least 20 million people worldwide survive a heart attack or stroke. Most of them, will then be prescribed a veritable cocktail of drugs including lipid-lowering agents, beta blockers, aspirin, anti-platelet medications, and angiotensin modulators.

In the misguided belief that this polypharmacy will guard against future catastrophic cardiovascular events, many patients think they don’t need to follow a healthy diet.

However a new, 5-year study of almost 32,000 patients in 40 countries showed those who ate a heart-healthy diet rich in fruits, vegetables and fish had an average:

  • 35% reduction in risk for cardiovascular death
  • 14% reduction in risk for new heart attacks
  • 28% reduction in risk for congestive heart failure
  • 19% reduction in risk for stroke

Healthy-Eating-and-Weight-LossResearchers from McMaster University were able to demonstrate, for the first time, that while drug treatments, substantially lower the risk of another heart attack, a high quality diet also significantly lowers the risk.

Mahshid Dehghan, the study’s lead author and nutritionist at McMaster University’s Population Health Research Institute (PHRI) and his team assessed the association between diet quality and the risk of cardiovascular disease using information collected from men and women who participated in two major McMaster-led global studies: ONTARGET, and TRANSCEND.

Participants with cardiovascular disease were asked how often they consumed milk, vegetables, fruits, grains, fish, nuts, meat and poultry over the past 12 months. They were also asked about lifestyle choices such as alcohol consumption, smoking and exercise. A healthy diet was indicated by a high intake of fruits, vegetables, whole grains and nuts as well as a high intake of fish compared to meat, poultry and eggs.

Clipart Illustration of a Healthy Red Heart Running PastThe results showed that a heart-healthy diet offered a “consistent benefit” over and above the benefits of taking medications to reduce the risk of heart attack and stroke.

Globally, healthy eating was associated with a lower risk of cardiovascular disease by more than 20% in all regions of the world and across all income groups.

Physicians should advise their high-risk patients to improve their diet and eat more vegetables, fruits, grains and fish,” Dehghan said. “This could substantially reduce cardiovascular recurrence beyond drug therapy alone and save lives globally.”

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Springing Forward Safely

SRxA’s Word on Health reminds you to turns your clocks forward an hour before going to bed tomorrow night. But as your dream of that extra hour of daylight, remember all good things come with a price.  First, the switch to summer time means we all lose an hours’ sleep. More worryingly, the time change may be bad for your health.

According to experts at the University of Alabama in the days immediately following the time change your risk of having a heart attack goes up by about 10%.

Because the Sunday morning of the time change doesn’t require an abrupt schedule change for most people, the elevated risk doesn’t kick in until Monday when people rise earlier to go to work.

Interestingly, the opposite happens in the fall, when we turn the clocks back. Then, the risk of heart attacks drops by 10%.

Exactly why this happens is not known but there are several theories,” says Associate Professor Martin Young, Ph.D. from the University of Alabama’s Division of Cardiovascular Disease.  “Sleep deprivation, the body’s circadian clock and immune responses all can come into play when considering reasons that changing the time by an hour can be detrimental to someone’s health.”

Young offers several possible explanations:

Individuals who are sleep-deprived weigh more and are at an increased risk of developing diabetes or heart disease. Sleep deprivation also can alter other body processes, including inflammatory response, which can contribute to a heart attack. Apparently, your reaction to sleep deprivation and the time change also depends on whether you are a morning person or night owl. Night owls have a much more difficult time with springing forward.

Circadian clock – every cell in the body has its own clock that allows it to anticipate when something is going to happen and prepare for it. When there is a shift, such as springing forward, it takes a while for the cells to readjust. It’s comparable to knowing that you have a meeting at 2 p.m. and having time to prepare your presentation instead of being told at the last minute and not being able to prepare.

Immune function – immune cells have a clock, and the immune response depends greatly on the time of day. In animal studies, when a mouse is given a sub-lethal dose of an endotoxin that elicits a strong immune response, survival depends upon the time of day they were given this endotoxin. Mice that were put through a phased advance much like Daylight Savings Time, and then had a challenge to their immune system, died, whereas the control animals that were not subjected to a phased advance survive when given the same dose of the toxin.

Fortunately, the body’s clock eventually synchs to the new time on its own.  In the meantime we offer you some tips to help you ease your body into the adjustment.

  • Wake up 30 minutes earlier on Saturday and Sunday than you need to in preparation for the early start on Monday
  • Eat a decent-sized breakfast
  • Go outside in the sunlight in the early morning
  • Exercise in the mornings over the weekend

These tricks will help reset both the master, clock in the brain that reacts to changes in light/dark cycles, and the peripheral clocks — the ones everywhere else including the one in the heart — that react to food intake and physical activity, thereby reducing the chance of a heart attack on Monday.

Assuming we all survive the annual time change shock to our system, we look forward to seeing you back here after the weekend.

Heart Health Hits Home

As I child, I didn’t understand the concept of death, as an adolescent I thought  I was invincible, as a young adult, death was something that happened to grandparents, parents and their friends. But now I’ve come to the point in my life, maybe it’s the final step in growing up, when I suddenly realize it could happen to me.

Why the sudden comprehension of mortality?

Last week, two of my closest friends almost died.  One was sitting in my kitchen, drinking wine and catching up on the latest neighborhood gossip, when he remarked he didn’t feel well. A few questions and a blood pressure reading later, we were testing the limits of my car’s performance on route to the local Emergency Department. A few hours and a few tests later, he was in a Medevac helicopter and on his way to emergency cardiac surgery. Thankfully, he’s home now, doing well and embellishing the story of his MASSIVE heart attack, brush with death, and quadruple bypass surgery with each passing day. (Actually it was just a stent, placed under local anesthetic – but let that be our secret, I wouldn’t want to ruin his 15 minutes of fame!)

The other , a fabulous, funny, vibrant woman, suffered a thrombotic stroke and also ended up being hospitalized and having surgery.

Prior to these events, both friends had been generally healthy. They both exercised, they both watched their weight and neither saw these life-changing events coming. Their brush with mortality was the wake-up call they needed, and further lifestyle changes are being implemented as we speak.

It was also the wake-up call I needed. Yesterday I rejoined the gym and resolved to exercise more, eat and drink less and visit my doctor more often.  Nearly losing my friends was the inspiration I needed.

Cardiovascular disease is the leading cause of death in the United States; one in every three deaths is from heart disease and stroke, equal to 2,200 deaths per day.

“Heart disease takes the lives of far too many people in this country, depriving their families and communities of someone they love and care for—a father, a mother, a wife, a friend, a neighbor, a spouse. With more than 2 million heart attacks and strokes a year, and 800,000 deaths, just about all of us have been touched by someone who has had heart disease, heart attack, or a stroke.”  says Department of Health and Human Services Secretary, Kathleen Sebelius.

Recently, the American Heart Association/American Stroke Association  joined forces with Million Hearts™ to build healthier lives free of cardiovascular disease and stroke. As part of this they have developed a heart attack risk calculator and a life check calculator to help you understand your cardiovascular health and move you closer to your life goals.

For those, still looking for a motive, I highly recommend viewing a “Living Proof” video, created by physicians, nurses and patients at MetroSouth Medical Center.

In it, heart disease survivors and those who have lost loved ones to heart conditions used cardboard signs to deliver an urgent call to action. Their main messages?  Get screened for heart disease and early intervention and prevention pays off.

February is National Heart Month and I for one am taking notice.  Are you?

Were You Heartbroken this Valentine’s Day?

Did your loved one forget the flowers or cancel the candlelight yesterday? Worse still, did cupids arrow miss entirely, and you ended up getting ditched or dumped?

If so, you may well be feeling brokenhearted today. And before someone tells you there’s no such thing as a broken heart, take heart!

According to Dr. Binh An P. Phan, a cardiologist at  Loyola University, a broken heart is an actual medical condition. Broken heart syndrome can occur during highly stressful or emotional times, such as a painful breakup, the death of a spouse, the loss of a job or extreme anger.

Not that you’ll find the term “broken heart syndrome” in any medical text book.  Professionals refer to it as stress cardiomyopathy. During an extremely stressful event, the heart can be overwhelmed by a surge of adrenalin and other stress hormones. This can cause a narrowing of the arteries that supply blood to the heart, similar to what happens during a heart attack. Symptoms are also similar to those of a heart attack, and include chest pain and difficulty breathing.

But, unlike a heart attack, broken heart syndrome is reversible.  Over time, the symptoms go away. And unlike heart attack patients, people with broken heart syndrome do not suffer lasting damage to their hearts.  Their wallets maybe, their pride – almost certainly – but not their hearts!

Still, as it’s difficult to distinguish between broken heart syndrome and a heart attack, SRxA’s Word on Health advises anyone experiencing symptoms such as chest pain and difficulty breathing to call 911.

Who knows?  You could even meet your Valentine while getting checked out at the hospital!

I Spy an AED

SRxA’s Word on Health loves a good challenge – and they don’t come much better than this.  A group of researchers from the University of Pennsylvania are set to save lives with cell phone cameras… and they need help.

The MyHeartMap Challenge, will be a month-long contest starting in mid January. It will invite Philadelphians to the streets and social media sites to locate as many automated external defibrillators (AEDs) as they can. AEDs are lifesaving devices used to deliver a controlled electric shock and restore normal cardiac rhythm following a heart attack.  AED’s are widely used in hospitals and by pre-hospital providers such as EMT’s; but they can also be used by people with no medical training since they provide audio instructions that talk users through the process of performing CPR and defibrillation.

There’s an estimated one million AEDs across the nation. Some are hung clearly on the walls in airports and casinos, but others are tucked away in restaurant closets and under cash registers in coffee shops. Since  AEDs are not subject to regulations that would allow their makers to know where or when their devices are being used there’s currently no uniform system to track their location.

The contest hopes to change that.  Furthermore, it’s just a first step in what the Penn team hopes will grow to become a nationwide AED registry project that will put the lifesaving devices in the hands of anyone, anywhere, anytime.

Armed with a free app on their mobile phones, contest participants will snap pictures of the lifesaving devices wherever they find them in public places around the city. Contestants will then use the app to geotag the photos with their location and details about the device and send them to the research team via the app itself or the project’s web site.

The data collected will be used to create an updated app linking locations of all public AEDs in the city with a person’s GPS coordinates to help them locate the nearest AED during an emergency.

Better still – the person or team who finds the most AEDs during the contest will win $10,000. Additionally, people who find various pre-located “golden AEDs” around the city will win $50.

More and more, scientists are learning that we can benefit from the wisdom of the crowd,” says MyHeartMap Challenge leader Raina Merchant, MD, Assistant Professor of Emergency Medicine. “Participation from ordinary citizens will allow us to answer questions and make the city safer than our team could ever do on its own.”

MyHeartMap Challenge participants can register as individuals or teams, and the Penn researchers suggest participants develop creative ways to maximize their chances of winning. If, for instance, a team can figure out how to use their social networks via Twitter and Facebook to engage people who work in public locations in Philadelphia to take photos of AEDs, the team could win $10,000 dollars without even leaving their desks. These “virtual teams” could prove to be faster and more efficient than any individual working alone. Participants can also organize AED scavenger hunts or mini-contests to locate all the AEDs in a workplace building, or compete against friends to see who can find the most devices. The researchers encourage participants to start strategizing and forming teams now so they can be first out of the gate to win.

What are you waiting for?

Man develops own life-saving heart implant

A serious heart problem inspired a man with Marfan syndrome to develop a device that offers hope not just for himself but for thousands of other patients with the same condition.

In 2000, Tal Golesworthy, a process engineer from the UK, was told that the aortic root in his heart had expanded and was in danger of splitting. He had two choices; undergo surgery to insert a mechanical valve or risk a sudden and fatal heart attack.

The first option filled him with almost as much dread as the second. Surgery would involve cutting out the damaged section of the artery  and replacing it with a piece of tubing. It would also mean that he would be placed on warfarin, a blood-thinning drug, also used as rat poison, which carries the risk of severe bleeding. “That’s not something I wanted to rely on for the rest of my life,” said Golesworthy. “The thought of that dismayed me more so than the surgery.”

Golesworthy thought he could engineer a better solution. What excited him was the use of. He believed that by combining magnetic resonance imaging (MRI) and computer-aided design (CAD) with rapid prototyping (RP) techniques he could manufacture a tailor-made support that would act as an internal bandage to keep his aorta in place.

The concept, he hoped, would reduce the risk of harmful clots forming due to the mechanical valve and importantly, eliminate the need to take warfarin. Time was crucial if Golesworthy was to save himself. So he enlisted the help of Prof Tom Treasure, a cardiothoracic surgeon at Guy’s Hospital, and Prof John Pepper, a surgeon from the Royal Brompton Hospital.

Although conceptually, it was very simple to do, the actual engineering was significantly more complex.” explained Golesworthy.

He set about devising a means of wrapping the aorta in a sleeve to prevent it expanding, and came up with a solution called Ears — external aortic root support — which is now being marketed through his firm, Exstent.    The team looked at a number of different processes, such as 3D embroidery, but ended up using a standard medical polymer, polyethylene terephthalate (PET) in a textile solution. The mesh weighed less than 5g, was an exact fit for the ascending aorta and could be sutured into place by the surgeon.  Each sleeve is created using scans of the individual patient’s aorta and computer-assisted drawing to produce a bespoke device.

The process, from proposal to final product, took just under two years.  “My aorta was dilating all through that period,’”said Golesworthy.

Golesworthy believes that projects such as this demonstrate that the interface between engineers and the rest of the world isn’t functioning in the way it should. “When it does function, huge advances can be made in a very short time period, on very little money,” he said. “We have changed the world for people with aortic dilation and we have done it on a fraction of the cost.”

In May 2004, Golesworthy became the first recipient of his own invention.  Since then, 23 patients have successfully had the implant fitted and another seven are hoping to undergo the procedure.

Word on Health is continually amazed at what people can do when their life is on the line. Although as  Golesworthy himself says “When you’ve got the scalpel of Damocles hanging over your sternum, it motivates you into making things happen.”

One less guilty pleasure?!?

The 2010 Easter holiday just got better for chocolate lovers.  A study published this week in the European Heart Journal showed that chocolate is good for you.

The ten-year study of chocolate consumption in almost 20,000 people showed that those who ate the most chocolate got the greatest benefit.  German nutritionists found that eating 7.5 grams of dark chocolate every day could reduce the risk of heart attack or stroke by a staggering 39%. Chocolate eating can also lead to lower blood pressure.

As always, there’s a catch – it’s the most expensive chocolate that’s best for you.  Dark chocolate containing at least 70% cocoa produced the best results.

And before you rush out and stock up, you need to do the math.  7.5 grams is approximately 0.26 ounces, which is less than one small square. Eating more than this can result in obesity, which leads to higher blood pressure, which in turn increases the risk of heart attack and stroke!

Still, chocolate is chocolate, right?

Even so, Word on Health wonders whether it will continue to taste as good now that we know it’s good for us.