Pain Meds Double Risk of Heart Disease

I follow research articles on  a variety of health topics.  Often we have lots of “do this” research which promotes a certain type of action.  This week, I am promoting an article which is a “don’t do this” variety.  This article warns us of the dangers associated with certain types of pain medications.

The research is published in the July 2011 issue of the American Journal of Medicine.  “We found a significant increase in adverse cardiovascular outcomes,  primary driven by an increase in cardiovascular mortality,” lead author Dr Anthony A Bavry; (University of Florida, Gainesville) told heartwire . “This is not the first study to show there  is potential harm with these agents, but I think it further solidifies  that concern.” As a chiropractor in St George Utah, I am concerned about the amount of pain medications that are being so liberally dispensed.  We have a strong and vibrant retirement community here and much of my pain management chiropractic practice is with the elderly.

Bavry and colleagues were not able to differentiate between NSAIDs in the study–most people were taking ibuprofennaproxen, or celecoxib–and  he says until further work is done, he considers the risks of NSAIDs “a  class effect,” and their use should be avoided wherever possible.

However, “Patients should not terminate these medicines on their  own,” he says. “They should have a discussion with their physician. When  I see patients like these taking NSAIDs I will have an informed  discussion with them and tell them there is evidence that these agents  may be associated with harm. I try to get them to switch to an  alternative agent, such as acetaminophen, or if that’s not  possible I at least try to get them to reduce the dose of NSAID or the  frequency of dosing. But ultimately, it’s up to them if this potential  risk is worth taking depending upon the indication for their use.”

Within the large cohort of more than 22 000 patients in INVEST, Bavry  and colleagues identified patients who reported taking NSAIDs at every  follow-up visit and termed them chronic users (n=882). Most often,  patients were taking these agents for conditions such as rheumatoid  arthritis, osteoarthritis, and lower back pain, Bavry said.

They compared the chronic NSAID users with those who only  intermittently (n=7286) or never (n=14 408) used NSAIDs over an average  of 2.7 years and adjusted the findings for potential confounders.

The primary outcome–a composite of all-cause death, nonfatal MI, or  nonfatal stroke–occurred at a rate of 4.4 events per 100 patient-years  in the chronic-NSAID group vs 3.7 events per 100 patient-years in the  nonchronic group (adjusted hazard ratio 1.47; p=0.0003).

As noted by Bavry, the end point was primarily driven by a more than  doubling in the risk of death from CV causes in the chronic-NSAID group  compared with never or infrequent users (adjusted HR 2.26; p<0.0001).

The association did not appear to be due to elevated blood pressure,  the researchers say, because chronic NSAID users actually had slightly  lower on-treatment BP over the follow-up period.

They note that a recent American Geriatrics Society panel on  the treatment of chronic pain in the elderly recommends acetaminophen as  a first-line agent and suggests that nonselective NSAIDs or COX-2  inhibitors be used only with extreme caution. “Our findings support this  recommendation,” they state.

Bavry added: “We do need more studies to further characterize the  risks of these agents, which are widely used and widely available, and  perhaps the risks are underappreciated. We are working on the next level  of studies to try to identify which are the most harmful agents.”

So how does this relate to us?  It means see your chiropractor instead of relying on pain meds.  Ibuprofen is not Vitamin I.  The Innova Pain Clinic in St George UT is a pain management chiropractic facility.  We are dedicated to improving health and reducing pain.  We focus on spinal trauma, such as whiplash and auto injury.

Dr. Andrew White

St George Chiropractor


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