ASPIRIN: the best NSAID

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ALL NON-ASPIRIN NSAIDS INCREASE MI

Carefully controlled study show that all class of non-aspirin NSAIDs cause increased risk of myocardial infraction. 

 

Another study showed that aspirin reduces MI 32%.

 

 

ARCHIVES OF INTERNAL MEDICINE,  Vol. 165 No. 9. May 9, 2005

 

Risk of Hospitalization for Myocardial Infarction Among Users of Rofecoxib, Celecoxib, and Other NSAIDs

A Population-Based Case-Control Study

Søren P. Johnsen, MD, PhD; Heidi Larsson, MSc; Robert E. Tarone, PhD; Joseph K. McLaughlin, PhD; Bente Nørgård, MD, PhD; Søren Friis, MD; Henrik T. Sørensen, DMSc

Arch Intern Med. 2005;165:978-984.

Background  It remains uncertain if the excess cardiovascular risk of rofecoxib and celecoxib reported in clinical trials is present in routine practice and whether the use of other nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) also carries an increased cardiovascular risk. We performed a population-based case-control study to examine the risk of myocardial infarction (MI) among users of various categories of nonaspirin NSAIDs.

Methods  Using data from hospital discharge registries in the counties of North Jutland, Viborg, and Aarhus, Denmark, and the Danish Civil Registration System, we identified 10 280 cases of first-time hospitalization for MI and 102 797 sex- and age-matched non-MI population controls. All prescriptions for nonaspirin NSAIDs filled before the date of admission for MI were identified using population-based prescription databases. Relative risk estimates for MI were adjusted for a history of cardiovascular disease, hypertension, diabetes mellitus, chronic bronchitis or emphysema, alcoholism, liver cirrhosis, upper gastrointestinal bleeding, rheumatoid arthritis, systemic lupus erythematosus and the use of high-dose aspirin, platelet inhibitors, insulin or oral hypoglycemic drugs, antihypertensive drugs, lipid-lowering drugs, oral anticoagulants, nitrates, penicillamine, gold, oral glucocorticocoids, and hormone therapy before the date of admission for MI.

Results  Current users of rofecoxib had an elevated risk estimate for hospitalization for MI compared with nonusers of any category of nonaspirin NSAIDs (adjusted relative risk [ARR], 1.80; 95% confidence interval [CI], 1.47-2.21). Increased risk estimates were also found among current users of celecoxib (ARR, 1.25; 95% CI, 0.97-1.62), other cyclooxygenase-2 selective inhibitors (ARR, 1.45; 95% CI, 1.09-1.93), naproxen (ARR, 1.50; 95% CI, 0.99-2.29), and other conventional non-aspirin NSAIDs (ARR, 1.68; 95% CI, 1.52-1.85). The highest ARRs were found among new users of all examined drug categories.

Conclusions  Current and new users of all classes of non-aspirin NSAIDs had elevated relative risk estimates for MI. Although the increased risk estimates may partly reflect unmeasured bias, they indicate the need for further examination of the cardiovascular safety of all non-aspirin NSAIDs.


Author Affiliations: Department of Clinical Epidemiology, Aarhus Hospital, Aarhus University Hospital, Aarhus, Denmark (Drs Johnsen, Nørgård, and Sørensen and Ms Larsson); Center of Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark (Dr Johnsen); International Epidemiology Institute, Rockville, Md (Drs Tarone and McLaughlin); Department of Medicine, Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, Tenn (Drs Tarone and McLaughlin); and Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark (Dr Friis).


 

 

 

From Harvard Health Publications at www.health.harvard.edu

 

Painkillers — new and old — increase the risk for heart attack, from the Harvard Heart Letter

BOSTON — Cardiovascular side effects aren’t limited to the use of the newer painkillers called COX-2 inhibitors — a category that includes Celebrex and the recently discontinued Vioxx and Bextra. Old standbys, like ibuprofen and aspirin, aren’t entirely blameless, reports the October 2006 issue of the Harvard Heart Letter. The cardiovascular risks associated with traditional NSAIDs are small, but worth being aware of.

Ibuprofen, aspirin, and COX-2s all belong to the class of medicines called nonsteroidal anti-inflammatory drugs (NSAIDs). Most of them boost blood pressure and can counteract the effect of some blood-pressure drugs. They can also impair blood vessels’ ability to relax and may stimulate the growth of smooth muscle cells inside arteries. All these changes can contribute to the artery-clogging process known as atherosclerosis.

Researchers have determined that use of a COX-2 inhibitor increases the chances of having a heart attack. Vioxx, which was taken off the market because of possible heart complications, may lead to or worsen heart failure — but so can traditional NSAIDs. In general, cardiovascular side effects are most likely to happen in people with existing heart disease or those at high risk for it.

It is very easy to take the safety of medications for granted, and sometimes we get a harsh reminder that even FDA-approved medications carry risks as well as benefits. Take, for example, the story of the pain relievers Vioxx and Bextra. These COX-2 specific nonsteroidal anti-inflammatory drugs (NSAIDs) were withdrawn from the market after being linked with cardiovascular problems. Now it turns out that even some of our old standby NSAIDs aspirin and ibuprofen carry some cardiovascular risks you should be aware of. This issue of HEALTHbeat explains these new concerns and who may be at particular risk.—Nancy Ferrair, Managing Editor of Harvard Health Publications. 

 

Unfortunate most doctors still are unaware that all NSAIDs promote the development of atherosclerosis—the one exception being ASPIRIN. The problem lies with the 800 pound guerrilla (big PHARMA) dominating the dissemination of medical information. 

http://www.ualberta.ca/~csps/JPPS7%283%29/F.Jamali/Vioxx.htm COX-2 selective inhibitors cardiac toxicity: getting to the heart of the matter.  Oct 2004.  Variations in Vigor and Approve studies etc.

http://en.wikipedia.org/wiki/Vioxx#Withdrawal Hiding data, different studies, withdraw of Vioxx.

evidence that inhibition of COX-2–derived PGI2 removes a protective constraint on thrombogenesis, hypertension, and atherogenesis in vivo.  http://www.jci.org/articles/view/27291

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