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Post by jeffolie on Jan 12, 2011 12:11:41 GMT -6
#1 Ibuprofen/Advil bad of 7 painkillers I am confused. My HMO recommends Olie and I take low dose aspirin to prevent heart attacks. Aspirin is not one to the 7 listed below as those that may increase the risk of heart attacks, stroke... Comments? ===================================================================================== Generic Painkillers May Increase Risk of Heart Attack, Stroke, Review Says Jan 11, 2011 Commonly prescribed medicines that ease pain by fighting inflammation have been linked to increased risk heart attack and stroke, scientists said. Naproxen, a generic medicine, appeared to be the least harmful of seven painkillers examined by the Swiss researchers, according to an analysis published today in the British Medical Journal. Ibuprofen, sold as Advil by New York-based Pfizer Inc., was found to be associated with the highest stroke risk, followed by another generic, diclofenac. The analysis bolsters research linking painkillers to health hazards. Vioxx, from Merck & Co. in Whitehouse Station, New Jersey, was withdrawn in 2004 because of heart risks, and Prexige, from Novartis AG in Basel, Switzerland, failed to win U.S. approval in 2007 after Australian regulators became concerned that the product may cause liver damage. Both Vioxx and Prexige were linked to twice the risk of a heart attack compared with a placebo, the analysis found. “This paper adds to the growing body of evidence” that regular use of the painkillers is associated with increased risk to the heart, said Simon Maxwell, chairman of the London-based British Pharmacological Society’s prescribing committee and a professor at the University of Edinburgh, said in a statement. Most patients take the medicines for short periods and would run a lower risk of any side effects, Maxwell said. ‘Excess Risk’ “Patients with chronic pain may find themselves using such drugs for more prolonged periods,” Maxwell said. “While this study suggests they might be exposed to some excess risk, the alternatives may be less acceptable. Living with pain severely impairs the quality of life.” The scientists, who were led by Sven Trelle, a senior research fellow at the University of Bern in Switzerland, examined the results of 31 trials, involving more than 116,000 patients. The studies looked at seven drugs: Pfizer’s Celebrex, Merck’s Vioxx and experimental etoricoxib, and Novartis’s Prexige, ibuprofen, naproxen and diclofenac. The analysis was funded by the Swiss National Science Foundation, based in Bern. www.bloomberg.com/news/2011-01-11/generic-painkillers-may-raise-heart-attack-stroke-risk-review-says.html
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Post by unlawflcombatnt on Jan 12, 2011 15:50:26 GMT -6
Thanks for posting this, Jeff.
I don't have time at the moment to fully analyze this. From what I've read so far, this is another Corporatistic fairy tale sponsored by Pfizer--designed to draw fire away from Pfizer's Celebrex.
It appears this article is trying to convey that Celebrex isn't any worse than other NSAIDs. It is no surprise that one of the authors has actually worked for Pfizer and has been paid by them.
Also, not surprisingly, the Bloomberg article doesn't reference any specific study--it simply makes a vague reference to "a study in BMJ." This vague reference was given in an attempt to lend credence to the story--but without enabling readers to easily verify the actual facts and findings in the study.
I was able to find some summaries of the study which, again, I will comment on more fully later.
However, I will say that the hazards of Ibuprofen are exaggerted, especially in comparison to Celebrex. There are a couple of reasons why.
Ibuprofen slightly reduces the beneficial anti-platelet effects of aspirin. Thus a person already on aspirin for inhibition of platelet aggregation will have a reduction in those effects during the time they're taking ibuprofen. Thus some of the cardiac thrombogenic effects are due to it reducing the effects of aspirin.
Celebrex would reduce the beneficial effects of aspirin even more than ibuprofen. However, most people taking Celebrex are specifically trying to avoid aspirin use to prevent bleeding complications--especially GI bleeding. Thus the deleterious effects of Celebrex are usually compared with those of non-Celebrex AND non-aspirin users. Thus Celebrex's effects are usually compared with a higher-risk placebo group, than is the case with Ibuprofen. So when assessing the relative risk, Ibuprofen is being compared with a lower CVD risk placebo group than is Celebrex.
Predictably, Celebrex looks less bad in those types of comparisons.
More importantly, however, is the cell physiology involved which is well-understood. Ibuprofen inhibits both pro-clotting and anti-clotting factors to a similar degree (technically, these are anti-platelet aggregation factors).
In contrast, Celebrex inhibits anti-clotting factors almost exclusively, with little inhibition of pro-clotting factors. The net result would be to increase clotting (platelet-aggregating) effects.
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Post by unlawflcombatnt on Jan 12, 2011 17:47:47 GMT -6
Below is a link to a particularly good reference to Celebrex's increasing the risk of heart attacks. In the highest dose group, Celebrex increased the chance of an myocardial infarction 3.4X. www.nejm.org/doi/pdf/10.1056/NEJMoa050405" The incidence of the prespecified composite cardiovascular end points, analyzed according to the time to the first event, and the associated hazard ratios are shown in Table 2. As compared with the placebo group, the group given 200 mg of celecoxib [Celebrex] twice daily had a hazard ratio for death from cardiovascular causes, myocardial infarction, stroke, or heart failure of 2.3 (95 percent confidence interval, 0.9 to 5.5), and the group receiving 400 mg of celecoxib twice daily had a hazard ratio of 3.4 (95 percent confidence interval, 1.4 to 7.8). The results for the individual components of the composite end point are shown in Table 3. There were six deaths in the placebo group, six in the group given 200 mg of celecoxib twice daily, and nine in the group given 400 mg twice daily, and one, three, and six of the deaths, respectively, were due to cardiovascular causes....
The annualized incidence of death from cardiovascular causes, stroke, myocardial infarction, or heart failure was 3.4 events per 1000 patient-years in the placebo group, 7.8 events per 1000 patientyears in the group given 200 mg of celecoxib twice daily, and 11.4 events per 1000 patient-years in the group given 400 mg twice daily." There are NO studies that show anything close to this degree of increase in heart attacks or strokes with ibuprofen usage.
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Post by jeffolie on Jan 17, 2011 11:20:56 GMT -6
2,000mg long term painkillers = 3 x strokes, heart attacks "taking three or four pills a day – a dose of up to 2,000mg – for several months or even years....stroke and heart risks only exist for those taking high doses of ibuprofen over long periods – and there is no danger in the odd pill for a headache, for example.... Researchers from the University of Bern in Switzerland looked at more than 31 clinical trials involving 116,429 patients.2,000mg long term painkillers = 3 x strokes, heart attacks ================================================================= Ibuprofen 'trebles the risk of a stroke' as doctors warn over dangers of long-term use 12th January 2011 Large regular doses of ibuprofen and similar painkillers could treble the risk of strokes and increase the likelihood of heart attacks, researchers are warning. Scientists have found high doses of ibuprofen may carry a similar health risk to painkillers that were withdrawn from the market several years ago on safety grounds. A study found people who had taken ibuprofen over a long period were almost three times as likely to suffer a stroke. Adverts have highlighted facial and arm weakness are early symptoms of stroke Up to eight million Britons are prescribed so-called anti-inflammatory drugs every year, usually to combat arthritis or back pain. Doctors stress that the stroke and heart risks only exist for those taking high doses of ibuprofen over long periods – and there is no danger in the odd pill for a headache, for example. Researchers from the University of Bern in Switzerland looked at more than 31 clinical trials involving 116,429 patients.They had each taken one of seven commonly-used painkillers, The study, published in the British Medical Journal, found that those who had taken ibuprofen over a long period of time were almost three times as likely to suffer a stroke. The painkiller was also shown to raise significantly the risk of heart attacks and deaths caused by heart disease. Another commonly prescribed pill, diclofenac, which is also sold under the trade name Rhumalgan, was shown to almost treble the risk of strokes and increase the likelihood of heart disease related death by four times. The study also suggested that ibuprofen carried a similar risk of stroke and death from heart disease to rofecoxib, also known as Vioxx, which was withdrawn from the market in 2004 over safety concerns. Professor Peter Jüni, of the University of Bern, said: ‘We looked at patients taking these drugs three to four times a day. ‘They were mainly being treated for osteoarthritis with a few who had rheumatoid arthritis. A lot of them are elderly who are already have lots of risk factors and these will then be duplicated with these painkillers. ‘In terms of stroke, ibuprofen doesn’t look very good. If I was in chronic pain I would not take it as the risks are just too high. I would look at the different options.’ But researchers say those at risk would have to be taking three or four pills a day – a dose of up to 2,000mg – for several months or even years. Professor Simon Maxwell, chairman of the British Pharmacological Society’s Prescribing Committee, said the finding should be taken in context. He added: ‘Most users of these drugs will only take them for a relatively brief duration to treat short-lasting episodes of pain and are at minimal risk.’ www.dailymail.co.uk/health/article-1346254/Ibuprofen-trebles-risk-stroke-doctors-warn.html
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Post by unlawflcombatnt on Jan 17, 2011 13:54:47 GMT -6
This is another dubious report. Not surprisingly, no link or reference is provided to the study--which is always done in any serious scientific report. And again, this appears to be an overt attempt to exonerate Vioxx, by dishonestly inferring that Ibuprofen carries similar risks. It does not. The giveaway is the following line in the article: [/i]"[/ul] There has never been a study that showed, or even suggested, that the risk with Ibuprofen is similar to Vioxx (or Celebrex). The underlying truth here is that neither Vioxx or Celebrex should have ever been put on the market. Their potential hazards were well understood from a biochemical and physiological standpoint before they ever came to market. I refused to prescribe either one from the outset, based on these obvious risks--and despite Pfizer's assurance that there was no increased rate of MI's or CVA's. As time has now shown, Pfizer was wrong, and I was right. It's certainly possible that Ibuprofen increases the risk somewhat, but it's minuscule compared to the risk increase from Vioxx or Celebrex. Personally, I'll continue to take Ibuprofen when necessary. But I'll never take, nor have I ever taken Celebrex. (Vioxx has already been pulled from the market.) And I'll continue to prescribe Ibuprofen for patients whenever indicated or beneficial. This new "study" is simply regurgitating information from earlier, seriously-flawed, and seriously-biased studies. It should be remembered that the 1st study cited in this thread was done by a researcher who acknowledges being paid by Pfizer--the maker of Celebrex. True clinical drug research, which I'm involved in myself, requires the signing of a form attesting that the researcher has no financial connection to the drug company. This includes direct payment or any ownership. Again, the head researcher in the 1st study cited above freely admits to being paid by Pfizer--which has a clear-cut conflict of interest with generic producers of Ibuprofen. Sadly, unsubstantiated articles like the one referred to here are treated as gospel truth by the general public.
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Post by jeffolie on Jan 17, 2011 15:19:18 GMT -6
Thank you, unlc
I look to you as a shining light, point of truth in the health media fog.
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Post by whoswho on Jan 18, 2011 12:15:57 GMT -6
Aspirin tears my stomach up, ditto for some of those other over-the-counter wonders.
I started taking more Vitamin E (800 IE) to thin my blood, at least it's kind to my stomach.
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