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NSAIDS Linked To Heart Attack Stroke
Earlier this year, a study in the American Heart Associations journal Circulation reported an increased risk of heart attack with use of nonsteroidal anti-inflammatory drugs (NSAIDs) in healthy individuals (over 1 million individuals included in the analysis).1 It wasnt the first study to find this risk with NSAIDS; however, prior studies looked at those who had heart disease or were at increased risk for it, not apparently healthy people.
Last month at the European Society of Cardiologys 2010 Congress, the same authors reported an increased risk for stroke with use of NSAIDS in a similar large and healthy Danish population. Speaking to Heartwire, Dr. Gunnar Gislason, one of the authors said:
Mechanism
NSAIDS are thought to increase cardiovascular and cerebrovascular risk via:
________
1 Cause-Specific Cardiovascular Risk Associated With Nonsteroidal Antiinflammatory Drugs Among Healthy Individuals, Circulation, 2010
2 NSAIDs, Coxibs, and Cardio-Renal Physiology: A Mechanism-Based Evaluation: Coxibs and Hypertension, Medscape, 2002
3 Renal Effects Of Cyclooxygyenase-2-Selective Inhibitors, Journal of Pain and Symptom Management, 2002
NSAIDS Linked To Heart Attack Stroke
Thursday, March 27, 2014
Earlier this year, a study in the American Heart Associations journal Circulation reported an increased risk of heart attack with use of nonsteroidal anti-inflammatory drugs (NSAIDs) in healthy individuals (over 1 million individuals included in the analysis).1 It wasnt the first study to find this risk with NSAIDS; however, prior studies looked at those who had heart disease or were at increased risk for it, not apparently healthy people.Last month at the European Society of Cardiologys 2010 Congress, the same authors reported an increased risk for stroke with use of NSAIDS in a similar large and healthy Danish population. Speaking to Heartwire, Dr. Gunnar Gislason, one of the authors said:
"This is very serious, as these drugs are very widely used, with many available over the counter. ... We need to get the message out to healthcare authorities that these drugs need to be regulated more caully."Gislason thinks NSAIDS need better management, perring they not be available without a prescription:
"If half the population takes these drugs, even on an occasional basis, then this could be responsible for a 50% to 100% increase in stroke risk. It is an enormous effect."Examples of NSAIDS currently available in the US without prescription are ibuprofen (e.g. Motrin and Advil) and naproxen (Aleve). Diclofenac (e.g. Voltaren and Cataflam), celecoxib (Celebrex), and rofecoxib (Vioxx, now withdrawn) are NSAIDS that require a prescription.
Mechanism
NSAIDS are thought to increase cardiovascular and cerebrovascular risk via:
- Increased coagulative effect, with risk of thrombus.
- Increased bleeding, especially associated with stroke.
- Increased blood pressure. (This is an effect of all NSAIDS.)2
- Adverse effects on kidneys. (NSAIDS can lead to sodium and water retention, and a decrease in glomerular filtration rate (GFR).)3
1 Cause-Specific Cardiovascular Risk Associated With Nonsteroidal Antiinflammatory Drugs Among Healthy Individuals, Circulation, 2010
2 NSAIDs, Coxibs, and Cardio-Renal Physiology: A Mechanism-Based Evaluation: Coxibs and Hypertension, Medscape, 2002
3 Renal Effects Of Cyclooxygyenase-2-Selective Inhibitors, Journal of Pain and Symptom Management, 2002
"[NSAIDS] are associated with adverse renal effects caused by the reduction in synthesis of renal prostaglandins through inhibition of cyclooxygenase (COX)."
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