Monday, October 17, 2016

Could Prescribed NSAID Painkillers Raise Heart Failure Risk?

Use of prescription-strength ibuprofen, naproxen and other commonly used pain relievers may be tied to a higher risk of heart failure, researchers report. These medications known as NSAIDs, may raise a person’s relative risk of heart failure by nearly 20%, according to the analysis of medical records.

The risk increases with the amount of NSAIDs a person is taking, said study author Andrea Arfe, a Ph.D. student at University of Milano-Bicocca, in Italy.

“Our findings – which focused only on prescription NSAIDs – might apply to over-the-counter NSAIDs as well,” Arfe said. “Although over-the-counter NSAIDs are typically used at lower doses and for shorter durations, they are sometimes available at the same doses as prescription NSAIDs and they may be inappropriately overused.

The findings were reported Sept. 28 in the BMJ.

According to the American Academy of Orthopaedic Surgeons (AAOS), NSAIDs decrease inflammation and pain by blocking an enzyme called cyclooxygenase. This enzyme comes in two forms, COX-1 and COX-2. COX-1 protects the stomach lining from digestive acids, while COX-2 is produced by injured or inflamed joints.

Traditional NSAIDs – like aspirin or ibuprofen – block the action of both COX-1 and COX-2, which is why some people suffer from stomach upset after taking them, the AAOS said. Newer NSAIDs like celecoxib (Celebrex) target only COX-2, and are referred to as COX-2 inhibitors.

“These drugs have been around for a long time, and they have important pain relief and anti-inflammatory properties, but they also have cardiovascular side effects,” said Dr. Christopher O’Connor, editor-in-chief of the cardiology journal JACC: Heart Failure. They have been shown to hold onto sodium, and there’s some reduction in kidney function.

The researchers concluded that people who’d been prescribed an NSAID within the preceding two weeks had a 19% increased risk of hospital admission for heart failure.

My Take:
All the research indicates NSAIDs are effective for short term reduction of prostaglandin 2 inflammation – about 72 hours. After 3 days, the reduction of prostaglandin 1 and prostaglandin 3 pathways, which are anti-inflammatory, undermines the benefits of these drugs.

Unfortunately, that is not how these drugs are marketed or prescribed. Television ads regularly recommend Aleve or naproxen be taken “just twice a day” with no restriction on duration.

Even the so called “baby aspirin” at one-third the dosage of regular aspirin causes gastrointestinal bleeding each and every time it is taken.

Blocking the PG1 and PG3 pathways inhibits the body from protecting vital organs from oxidative stress. Heart failure is only the third most common form of death from NASIDs. GI bleeds and liver failure are much more common causes of death from chronic NASID use.

The Bottom Line:
NASIDs have very limited, short term applications for pain relief. Honestly, I get a better response with my patients using fish oil, Turmeric, black current seed oil, and sesame seed oil. Clinically, prostaglandin inflammation predominates in about 60% of pain syndromes. The remaining 40% are alternate pathways that will not respond to NSAIDs.

Could Prescribed NSAID Painkillers Raise Heart Failure Risk?

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