Researchers Try to Quantify NSAID Risks

New research can help clinicians make more informed decisions about using nonsteroidal anti-inflammatory drugs to treat chronic pain. (Image: Michael Wolf/iStockphoto.com)

New research can help clinicians make more informed decisions about using nonsteroidal anti-inflammatory drugs to treat chronic pain. (Image: Michael Wolf/iStockphoto.com)

A new analysis confirms many of the risks and benefits of commonly used painkillers but quantifies them in ways that should help clinicians and patients make more informed decisions about using the drugs to treat chronic pain.

The meta-analysis, published online today in The Lancet, includes more than 600 clinical trials that evaluated about 353 000 patients. Researchers with the Coxib and traditional NSAID Trialists’ (CNT) Collaboration wanted to provide more reliable estimates of the effect that nonsteroidal anti-inflammatory drugs, known as NSAIDs, have on vascular and coronary events such as heart attacks, strokes, and death as well as on gastrointestinal complications including perforations, obstructions, or bleeding.

“There has been uncertainty about the nature and magnitude of these risks, and the relative safety of different NSAID regimens, especially in those at increased risk of coronary heart disease,” the researchers wrote.

They assessed risks associated with traditional NSAIDs such as ibuprofen, diclofenac, and naproxen as well as newer-generation formulations known collectively as coxibs because they selectively inhibit the COX-2 enzyme involved with pain and inflammation. COX-2 inhibitors were perceived to be as effective as traditional NSAIDs, with the added advantage of posing less risk of causing gastrointestinal upset. But subsequent studies showed they increased the risk of heart attacks and stroke, and the coxib rofecoxib was pulled from the market in 2004.

The new analysis showed that, compared with placebo, high doses of coxibs or diclofenac increased the risk of major vascular events, primarily heart attacks, by one-third. Ibuprofen more than doubled the risk of major coronary events compared with placebo but had no significant effect on the risk of vascular complications. High doses of naproxen weren’t associated with increased vascular or coronary risk.

All of the NSAIDs studied, including naproxen, roughly doubled the risk of being hospitalized because of congestive heart failure. All NSAIDs were linked with a 2- to 4-fold increased risk of gastrointestinal complications, primarily bleeding. The lowest risk was associated with using coxibs.

The overall results mean that, compared with placebo, about 3 excess major vascular events, including 1 death, could be expected annually in 1000 patients taking high-dose diclofenac or a coxib. But for every 1000 patients at high risk of major vascular events, taking a coxib or high-dose diclofenac would result in an additional 7 or 8 of those events occurring, about 2 that would be fatal.

The researchers said their findings “indicate that the effects of different regimens in particular patients can be predicted, which could help in guiding decisions about the clinical management of inflammatory disorders.”

Clot Removal Appears No Better Than Standard Therapy for Ischemic Stroke

A new study shows that invasive blood clot removal is no more effective than standard treatment for severe ischemic stroke, even in patients with more functional brain tissue. (Image: Donald Erickson/iStockphoto.com)

A new study shows that invasive blood clot removal is no more effective than standard treatment for severe ischemic stroke, even in patients with more functional brain tissue. (Image: Donald Erickson/iStockphoto.com

It seems logical that patients with more functional brain tissue after a severe ischemic stroke would reap greater benefits from removing the triggering clot than survivors with less viable tissue. But research presented today at the International Stroke Conference in Honolulu showed that clot removal was no more effective than standard antiplatelet therapy such as aspirin, even when researchers used brain scans to determine which patients with sufficient viable tissue might benefit from clot removal. Continue reading

American Heart Association: Claims That Gum Disease Promotes Cardiovascular Disease Are Unproven

Claims that good dental hygiene and gum disease treatment can prevent cardiovascular disease are unproven, according to a statement from the American Heart Association. (Image: iStockphoto.com/JoKMedia).

There is no proof that gum disease contributes to heart disease or stroke, and evidence to date is insufficient to back claims that treating gum disease can prevent such conditions, according to a scientific statement published today in Circulation by the American Heart Association.

Observational studies have found that gum disease and cardiovascular disease often co-occur. This has led some researchers to hypothesize that periodontal disease might contribute to cardiovascular disease. One potential mechanism that has been proposed is that the inflammation associated with gum disease promotes systemic inflammation that may lead to myocardial infarction, stroke, peripheral artery disease, and sudden cardiac death. However, a review of more than 500 studies by a committee of cardiologists, dentists, and infectious disease specialists convened by the AHA found no proof of a causative link. Continue reading

Author Insight: Stroke Risk May be Elevated Among Smokers of Mentholated Cigarettes

Nicholas T. Vozoris, MD, a clinical associate at St Michael’s Hospital in Toronto, and his colleagues found that women and nonblack individuals who smoked mentholated cigarettes had an elevated risk of stroke compared with those who smoked nonmentholated cigarettes. Image: Nicholas T. Vozoris

Smoking mentholated cigarettes may increase stroke risk in certain individuals, a study published today in the Archives of Internal Medicine suggests.

Many questions remain about the health effects of smoking mentholated vs nonmentholated cigarettes. Some evidence suggests that smoking mentholated cigarettes increases the likelihood of developing a smoking habit. Other data suggest that smokers of mentholated cigarettes may actually have a lower risk of lung cancer than smokers of nonmentholated cigarettes. But little information exists on noncancer health outcomes, so Nicholas T. Vozoris, MD, a clinical associate at St Michael’s Hospital in Toronto, and his colleagues examined data on about 5000 smokers from the 2001-2008 US National Health and Nutrition Examination Surveys to determine if cardiac health problems differed between smokers of mentholated versus nonmentholated cigarettes. Continue reading

Sleep Duration—Too Long or Too Short—Appears Linked With Cardiovascular Problems

Sleeping less than 6 hours or more than 8 hours may increase the risk for various cardiovascular complications. (Image: Nicole S. Young/iStockphoto.com)

Chicago—Getting the proper amount of sleep appears protective against experiencing heart problems or stroke.

At today’s scientific session of the American College of Cardiology here in Chicago, researchers presented findings suggesting that those sleeping less than 6 hours of sleep per night are twice as likely as those sleeping 6 to 8 hours per night to experience a stroke or heart attack and 60% more likely to have congestive heart failure. At the other end of the spectrum, those who sleep more than 8 hours per night are twice as likely as those who sleep 6 to 8 hours each night to have angina and they also have a 10% higher chance of having coronary artery disease. Continue reading

“Ministrokes” Linked With Lower Life Expectancy

Transient ischemic attacks, often called ministrokes, may reduce life expectancy by up to 20%. (Image: Barbara Reddoch/iStockphoto.com)

A transient ischemic attack (TIA) isn’t just a harbinger of stroke. New research shows that TIAs, which often are called ministrokes, can cut life expectancy by up to 20%.

The study, published online today in Stroke: Journal of the American Heart Association, is the first to examine life expectancy in people who have had a TIA compared with expected mortality rates from all causes of death in the general population. An estimated 240 000 TIAs occurred in the United States in 2002. Studies show that about 15% of strokes are preceded by a TIA. Continue reading

Trial Finds Medical Therapy Alone Best for Stroke Patients

Placement of a stent to reopen a brain artery in patients who had a stroke leads to worse outcomes than providing aggressive medical treatment alone, a randomized trial has found. (Image: forestpath/iStockphoto.com)

Patients who have experienced a stroke are more likely to benefit from receiving aggressive medical therapy alone than receiving such therapy plus the insertion of a stent to reopen a blocked intracranial artery, according to results of an important randomized clinical trial published online today in the New England Journal of Medicine.

The use of brain stents in patients who have had a stroke, which was presumed to help reduce the risk of future strokes, has become a common practice. But the new study found that aggressive medical therapy alone (including aspirin, clopidogrel for 90 days, and management of risk factors) was superior to such medical therapy plus the insertion of a stent in the intracranial artery.

Specifically, the researchers found that medical management alone was associated with a substantially lower risk of subsequent stroke in patients who had a 70% to 99% blockage of that artery. In fact, the trial’s data and safety monitoring board halted the study after 451 patients were enrolled because the risk of having another stroke within 30 days after enrollment was 14.7% in the stent group and only 5.8% in the medical therapy alone group. Continue reading