Miners used to take a canary with them into the coal mine because if the bird died, the air had gone bad and it was time to get out of the mine. Heart attack patients are like those canaries. They are more vulnerable than healthy people to cardiac events, so they serve as an early warning system for heart risks. These heart attack survivors have just sent out a big alert about the dangers of pain relievers!
Danish researchers identified nearly 100,000 patients over the age of 30 who had experienced a first-time heart attack sometime between 1997 and 2009. They were followed for up to 5 years after their initial heart attacks (Circulation, online, Sept 10, 2012). The scientists were especially interested in the post-heart attack use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as:
• Celecoxib (Celebrex)
• Ibuprofen (Advil, Motrin, etc)
• Diclofenac (Cataflam, Voltaren)
• Naproxen (Aleve, Naprosyn)
• Rofecoxib (Vioxx)
It should come as no surprise that heart attack patients, like the general population, take a lot of pain relievers. Because the Danish health care system reimburses medication expenses, all pharmacies keep records of dispensed prescriptions. That enabled these investigators to track prescribed NSAID use. Of the 99,187 patients in the study, nearly half (44%) filled a prescription for one of the pain relievers above.
And the envelope, please: It turns out that the heart attack survivors who took an NSAID-type pain reliever were at a substantially higher risk of having another heart attack or dying than those patients who did not take such drugs. In their first year following a heart attack, about one-fifth of the NSAID users died, compared to 12 percent of those not taking an NSAID-type pain reliever. Over the five years of the study, NSAID users were about twice as likely to die as non-users. They were also at increased risk for another heart attack. The investigators concluded:
“It would seem prudent to limit NSAID use among patients with cardiovascular disease and to get the message out to clinicians taking care of these patients that NSAIDs are potentially harmful, even 5 years after MI [myocardial infarction or heart attack].”
We would take this warning a step farther. As we stated at the beginning, heart attack patients are like canaries in the coal mine because they are more susceptible to repeat heart attacks. They also serve as a warning to the rest of us. Heart attack survivors may be more vulnerable, but we’re all at risk and they have just put up a huge red flag.
Ever since the great Vioxx scandal, there has been a growing recognition that most NSAIDs (except for aspirin) may pose a risk of heart attacks and strokes for the population at large–not just heart attack survivors. That’s because these drugs can increase blood pressure, affect blood vessel physiology and alter blood clotting. All these factors could be responsible for a greater susceptibility to blood clots that could cause heart attacks and strokes. This discovery has pretty much disappeared without a trace, however. Most people (including doctors) have ignored the warning.
The authors of the new article in Circulation note that doctors are prescribing NSAIDs to a vulnerable population in worrisome amounts (44% of the heart attack victims got a prescription for such drugs). The investigators also expressed concern that despite widespread knowledge about the risks of such drugs, some NSAIDs (ibuprofen and naproxen) are available without a prescription. By the way, naproxen (Aleve) appears to be a little less likely than other NSAIDs to cause cardiovascular complications but it has been associated with gastrointestinal bleeding, a complication of all NSAIDs.
Here’s the straight and skinny:
NSAIDs, whether prescription or over-the-counter, pose some serious risks, including heart attacks, strokes, bleeding ulcers or death. Other side effects include:
NSAID SIDE EFFECTS
• Heartburn, indigestion, abdominal pain, nausea, constipation
• Headache, dizziness, drowsiness, disorientation
• Skin rash, sensitivity to sunlight, itching (potentially serious, so notify the MD!)
• Fluid retention, edema, high blood pressure
• Heart failure
• Ringing in ears, hearing changes
• Visual disturbances
• Ulcers, bleeding ulcers, perforated ulcers
• Liver damage, kidney damage
• Blood disorders, anemia
• Worsening asthma symptoms
People swallow an extraordinary number of NSAIDs either because their doctor prescribes them or because they are readily available over-the-counter. Despite admonitions on the OTC label to take ibuprofen or naproxen for no longer than 10 days, many Americans take NSAIDs daily for weeks, months or years.
Only about one person out of five actually reads the directions on the label. Fewer than one in three checks out the dosing instructions. About one quarter take more than the recommended dose of OTC NSAIDs, and about half of the people in one survey did not realize that OTC pain relievers could cause any harm (Journal of Rheumatology, Nov. 2005).
Most people assume that if you can buy a drug without a prescription it must be safe. Nothing could be further from the truth, especially when it comes to NSAIDs. If you told people that the OTC pain reliever they are popping could cause a heart attack, stroke or death they would likely be surprised the FDA would permit such a thing. And if someone has a heart attack or dies while taking ibuprofen for a bad back, arthritis or a headache, chances are that the NSAID won’t be considered a contributing cause of the tragedy.
What’s a person to do if she has pain and does not want to risk the complications of an NSAID pain reliever? We offer dozens of non-drug options in our book, The People’s Pharmacy Quick & Handy Home Remedies. Herbs such as boswellia (p. 149), spices such as cayenne (p. 150) or turmeric (p. 152), supplements such as fish oil (p.154) or vitamin D (p. 158) and foods such as grape juice with Certo (p. 157), honey and vinegar (p. 156), pineapple juice (p. 156) and tart cherries (p. 153) have all provided relief for some people with joint pain.
Incorporating anti-inflammatory foods into tasty recipes is another approach to managing pain relief while limiting side effects. In our book Recipes & Remedies From The People’s Pharmacy, we offer instructions for remedies like cherry spritzer (p. 62), curcumin milk (p. 60), ginger pickle (p. 50), pineapple-cherry cocktail (p. 65), virgin raisins (p. 64) or anti-inflammatory curcumin scramble (p. 103). Adding fish to the diet in dishes such as favorite fish platter (p. 106), fish tacos with radish & lime (p. 120) horseradish-crusted salmon with cranberry catsup (p. 127), pescado al cilantro (p. 137) salmon with fava bean & spring pea mash (p. 141) or spicy fresh tuna salad (p. 143) puts anti-inflammatory power into everyday meals, and adds heart benefits rather than risks.
You can find all our books and guides in The People’s Pharmacy Store. And please reconsider routine use of NSAIDs like ibuprofen, meloxicam, naproxen and diclofenac. Such drugs may ease pain a bit, but the list of side effects is scary. People who have had heart attacks are not the only ones at risk for serious, even life-threatening complications.
We would love to hear your story about the pros and cons of NSAIDs. Have they worked without problems? Have you experienced side effects? Have you tried non-drug approaches for pain relief such as acupuncture or one of the herbs we mention above?
Share your experience below and thanks.