Re: Medical News: Study Finds CV Risk Even With Short-Term NSAID Use - in Cardiovascular, Myocardial Infarction Source: MedPage Today

[Guest guest]

My God, many of these are over the counter......

On 5/11/2011 5:42 AM, nandtbearden@... wrote:

http://www.medpagetoday.com/Cardiology/MyocardialInfarction/pda/26412

Study Finds CV Risk Even With Short-Term NSAID Use By Peggy Peck, Executive Editor, MedPage Today Reviewed by Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco Action Points

Explain that there is no "safe" duration for NSAID use in patients with a history of MI, and the use of NSAIDs after MI increased the relative risk of death or second MI by as much as 45%.

Note that the common NSAID diclofenac (Voltaren, Cataflam) was associated with a 3.52 hazard ratio for death during the first week of use, a higher risk of death at the initiation of treatment than was seen with Vioxx.

There is no "safe" duration for NSAID use in patients with a history of myocardial infarction, according to an analysis of data from more than 83,000 patients -- use of NSAIDs after MI increased the relative risk of death or second MI by as much as 45%.

Moreover, the common NSAID diclofenac (Voltaren, Cataflam) was associated with a 3.52 HR for death during the first week of use, according to Anne-Marie Schjerning Olsen, MB, of Copenhagen University Hospital in Gentofte, Denmark, and colleagues.

That's a higher risk of death at the initiation of treatment than was seen with rofecoxib (Vioxx), which was withdrawn from the market in 2004, they wrote online in Circulation, Journal of the American Heart Association.

"Our data challenge the current recommendation by the American Heart Association regarding NSAID treatment in patients with established cardiovascular disease, because we demonstrate that even short-term NSAID treatment is associated with increased cardiovascular risk in patients with prior MI; i.e., there essentially appears to be no safe therapeutic window for NSAID treatment," they concluded.

Denmark maintains detailed records of patient admissions, re-admissions, and medication use as well as a central death registry. Using those databases, Schjerning Olsen and her colleagues were able to identify 83,675 patients who were admitted to a hospital for treatment of a first MI over a 10 year period (1997-2006) and were able to link those patients on an individual basis to pharmacy records.

The mean age of patients was 68 and 63% of them were men.

During follow-up, 42.3% of the patients received NSAIDS and there were 35,257 deaths or recurrent MIs.

"In brief, overall NSAID treatment was associated with a statistically significantly increased risk of death at the beginning of the treatment, and the risk persisted throughout the course of treatment," the researchers wrote.

Patients taking rofecoxib had an increase in risk of death after taking the drug for a week to two weeks, while the other selective COX-2 inhibitor, celecoxib (Celebrex) had an increased risk of death when treatment lasted two weeks to a month.

Diclofenac "was associated with an increased risk from the beginning of treatment and the risk persisted throughout the course of treatment."

For ibuprofen, which was the most commonly used NSAID, the increased risk was seen for treatment lasting more than a week.

Among the findings: Cataflam(HR 1.45, 95% CI 1.29 to 1.62).

Naproxen increase the risk of death or recurrent MI by 76% after a week (HR 1.76, 95% CI 1.04 to 2.98), but for treatments lasting 30 to 90 days the risk increased risk was 15% (HR 1.15, 95% CI 0.80 to 1.65).

Ibuprofen had the lowest initial risk, just a 4% increase for treatments lasting seven days or less (HR 1.04, 95% CI 0.83 to 1.30).

The authors noted a number of limitations of the study, starting with its observational design.

Moreover, they noted that they were not able to determine the "precise indication for initiation of NSAID treatment. Thus, the disease or pain causing a condition treated with an NSAID could alone indicate a condition with increased risk of cardiovascular disease or death."

Information bias was another potential limitation as "patients do not necessarily take their medications consecutively, leading to the fact that the prescription may run longer and the patients therefore are exposed later than the database might indicate."

The authors said that more randomized clinical trials are warranted but, meanwhile, "the accumulating evidence suggests that we must limit NSAID use to the absolute minimum in patients with established cardiovascular disease."

The authors had no disclosures.

Take the Posttest Primary source: Circulation

Source reference: Schjerning Olsen AM, et al "Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction in patients with prior myocardial infarction a nationwide cohort study" Circulation 2011; DOI:10.1161/CIRCULATIONAHA.110.004671.

Sent via BlackBerry by AT & T

------------------------------------

[Guest guest]

My God, many of these are over the counter......

On 5/11/2011 5:42 AM, nandtbearden@... wrote:

http://www.medpagetoday.com/Cardiology/MyocardialInfarction/pda/26412

Study Finds CV Risk Even With Short-Term NSAID Use By Peggy Peck, Executive Editor, MedPage Today Reviewed by Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco Action Points

Explain that there is no "safe" duration for NSAID use in patients with a history of MI, and the use of NSAIDs after MI increased the relative risk of death or second MI by as much as 45%.

Note that the common NSAID diclofenac (Voltaren, Cataflam) was associated with a 3.52 hazard ratio for death during the first week of use, a higher risk of death at the initiation of treatment than was seen with Vioxx.

There is no "safe" duration for NSAID use in patients with a history of myocardial infarction, according to an analysis of data from more than 83,000 patients -- use of NSAIDs after MI increased the relative risk of death or second MI by as much as 45%.

Moreover, the common NSAID diclofenac (Voltaren, Cataflam) was associated with a 3.52 HR for death during the first week of use, according to Anne-Marie Schjerning Olsen, MB, of Copenhagen University Hospital in Gentofte, Denmark, and colleagues.

That's a higher risk of death at the initiation of treatment than was seen with rofecoxib (Vioxx), which was withdrawn from the market in 2004, they wrote online in Circulation, Journal of the American Heart Association.

"Our data challenge the current recommendation by the American Heart Association regarding NSAID treatment in patients with established cardiovascular disease, because we demonstrate that even short-term NSAID treatment is associated with increased cardiovascular risk in patients with prior MI; i.e., there essentially appears to be no safe therapeutic window for NSAID treatment," they concluded.

Denmark maintains detailed records of patient admissions, re-admissions, and medication use as well as a central death registry. Using those databases, Schjerning Olsen and her colleagues were able to identify 83,675 patients who were admitted to a hospital for treatment of a first MI over a 10 year period (1997-2006) and were able to link those patients on an individual basis to pharmacy records.

The mean age of patients was 68 and 63% of them were men.

During follow-up, 42.3% of the patients received NSAIDS and there were 35,257 deaths or recurrent MIs.

"In brief, overall NSAID treatment was associated with a statistically significantly increased risk of death at the beginning of the treatment, and the risk persisted throughout the course of treatment," the researchers wrote.

Patients taking rofecoxib had an increase in risk of death after taking the drug for a week to two weeks, while the other selective COX-2 inhibitor, celecoxib (Celebrex) had an increased risk of death when treatment lasted two weeks to a month.

Diclofenac "was associated with an increased risk from the beginning of treatment and the risk persisted throughout the course of treatment."

For ibuprofen, which was the most commonly used NSAID, the increased risk was seen for treatment lasting more than a week.

Among the findings: Cataflam(HR 1.45, 95% CI 1.29 to 1.62).

Naproxen increase the risk of death or recurrent MI by 76% after a week (HR 1.76, 95% CI 1.04 to 2.98), but for treatments lasting 30 to 90 days the risk increased risk was 15% (HR 1.15, 95% CI 0.80 to 1.65).

Ibuprofen had the lowest initial risk, just a 4% increase for treatments lasting seven days or less (HR 1.04, 95% CI 0.83 to 1.30).

The authors noted a number of limitations of the study, starting with its observational design.

Moreover, they noted that they were not able to determine the "precise indication for initiation of NSAID treatment. Thus, the disease or pain causing a condition treated with an NSAID could alone indicate a condition with increased risk of cardiovascular disease or death."

Information bias was another potential limitation as "patients do not necessarily take their medications consecutively, leading to the fact that the prescription may run longer and the patients therefore are exposed later than the database might indicate."

The authors said that more randomized clinical trials are warranted but, meanwhile, "the accumulating evidence suggests that we must limit NSAID use to the absolute minimum in patients with established cardiovascular disease."

The authors had no disclosures.

Take the Posttest Primary source: Circulation

Source reference: Schjerning Olsen AM, et al "Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction in patients with prior myocardial infarction a nationwide cohort study" Circulation 2011; DOI:10.1161/CIRCULATIONAHA.110.004671.

Sent via BlackBerry by AT & T

------------------------------------

[Guest guest]

My God, many of these are over the counter......

On 5/11/2011 5:42 AM, nandtbearden@... wrote:

http://www.medpagetoday.com/Cardiology/MyocardialInfarction/pda/26412

Study Finds CV Risk Even With Short-Term NSAID Use By Peggy Peck, Executive Editor, MedPage Today Reviewed by Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco Action Points

Explain that there is no "safe" duration for NSAID use in patients with a history of MI, and the use of NSAIDs after MI increased the relative risk of death or second MI by as much as 45%.

Note that the common NSAID diclofenac (Voltaren, Cataflam) was associated with a 3.52 hazard ratio for death during the first week of use, a higher risk of death at the initiation of treatment than was seen with Vioxx.

There is no "safe" duration for NSAID use in patients with a history of myocardial infarction, according to an analysis of data from more than 83,000 patients -- use of NSAIDs after MI increased the relative risk of death or second MI by as much as 45%.

Moreover, the common NSAID diclofenac (Voltaren, Cataflam) was associated with a 3.52 HR for death during the first week of use, according to Anne-Marie Schjerning Olsen, MB, of Copenhagen University Hospital in Gentofte, Denmark, and colleagues.

That's a higher risk of death at the initiation of treatment than was seen with rofecoxib (Vioxx), which was withdrawn from the market in 2004, they wrote online in Circulation, Journal of the American Heart Association.

"Our data challenge the current recommendation by the American Heart Association regarding NSAID treatment in patients with established cardiovascular disease, because we demonstrate that even short-term NSAID treatment is associated with increased cardiovascular risk in patients with prior MI; i.e., there essentially appears to be no safe therapeutic window for NSAID treatment," they concluded.

Denmark maintains detailed records of patient admissions, re-admissions, and medication use as well as a central death registry. Using those databases, Schjerning Olsen and her colleagues were able to identify 83,675 patients who were admitted to a hospital for treatment of a first MI over a 10 year period (1997-2006) and were able to link those patients on an individual basis to pharmacy records.

The mean age of patients was 68 and 63% of them were men.

During follow-up, 42.3% of the patients received NSAIDS and there were 35,257 deaths or recurrent MIs.

"In brief, overall NSAID treatment was associated with a statistically significantly increased risk of death at the beginning of the treatment, and the risk persisted throughout the course of treatment," the researchers wrote.

Patients taking rofecoxib had an increase in risk of death after taking the drug for a week to two weeks, while the other selective COX-2 inhibitor, celecoxib (Celebrex) had an increased risk of death when treatment lasted two weeks to a month.

Diclofenac "was associated with an increased risk from the beginning of treatment and the risk persisted throughout the course of treatment."

For ibuprofen, which was the most commonly used NSAID, the increased risk was seen for treatment lasting more than a week.

Among the findings: Cataflam(HR 1.45, 95% CI 1.29 to 1.62).

Naproxen increase the risk of death or recurrent MI by 76% after a week (HR 1.76, 95% CI 1.04 to 2.98), but for treatments lasting 30 to 90 days the risk increased risk was 15% (HR 1.15, 95% CI 0.80 to 1.65).

Ibuprofen had the lowest initial risk, just a 4% increase for treatments lasting seven days or less (HR 1.04, 95% CI 0.83 to 1.30).

The authors noted a number of limitations of the study, starting with its observational design.

Moreover, they noted that they were not able to determine the "precise indication for initiation of NSAID treatment. Thus, the disease or pain causing a condition treated with an NSAID could alone indicate a condition with increased risk of cardiovascular disease or death."

Information bias was another potential limitation as "patients do not necessarily take their medications consecutively, leading to the fact that the prescription may run longer and the patients therefore are exposed later than the database might indicate."

The authors said that more randomized clinical trials are warranted but, meanwhile, "the accumulating evidence suggests that we must limit NSAID use to the absolute minimum in patients with established cardiovascular disease."

The authors had no disclosures.

Take the Posttest Primary source: Circulation

Source reference: Schjerning Olsen AM, et al "Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction in patients with prior myocardial infarction a nationwide cohort study" Circulation 2011; DOI:10.1161/CIRCULATIONAHA.110.004671.

Sent via BlackBerry by AT & T

------------------------------------

[Guest guest]

My God, many of these are over the counter......

On 5/11/2011 5:42 AM, nandtbearden@... wrote:

http://www.medpagetoday.com/Cardiology/MyocardialInfarction/pda/26412

Study Finds CV Risk Even With Short-Term NSAID Use By Peggy Peck, Executive Editor, MedPage Today Reviewed by Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco Action Points

Explain that there is no "safe" duration for NSAID use in patients with a history of MI, and the use of NSAIDs after MI increased the relative risk of death or second MI by as much as 45%.

Note that the common NSAID diclofenac (Voltaren, Cataflam) was associated with a 3.52 hazard ratio for death during the first week of use, a higher risk of death at the initiation of treatment than was seen with Vioxx.

There is no "safe" duration for NSAID use in patients with a history of myocardial infarction, according to an analysis of data from more than 83,000 patients -- use of NSAIDs after MI increased the relative risk of death or second MI by as much as 45%.

Moreover, the common NSAID diclofenac (Voltaren, Cataflam) was associated with a 3.52 HR for death during the first week of use, according to Anne-Marie Schjerning Olsen, MB, of Copenhagen University Hospital in Gentofte, Denmark, and colleagues.

That's a higher risk of death at the initiation of treatment than was seen with rofecoxib (Vioxx), which was withdrawn from the market in 2004, they wrote online in Circulation, Journal of the American Heart Association.

"Our data challenge the current recommendation by the American Heart Association regarding NSAID treatment in patients with established cardiovascular disease, because we demonstrate that even short-term NSAID treatment is associated with increased cardiovascular risk in patients with prior MI; i.e., there essentially appears to be no safe therapeutic window for NSAID treatment," they concluded.

Denmark maintains detailed records of patient admissions, re-admissions, and medication use as well as a central death registry. Using those databases, Schjerning Olsen and her colleagues were able to identify 83,675 patients who were admitted to a hospital for treatment of a first MI over a 10 year period (1997-2006) and were able to link those patients on an individual basis to pharmacy records.

The mean age of patients was 68 and 63% of them were men.

During follow-up, 42.3% of the patients received NSAIDS and there were 35,257 deaths or recurrent MIs.

"In brief, overall NSAID treatment was associated with a statistically significantly increased risk of death at the beginning of the treatment, and the risk persisted throughout the course of treatment," the researchers wrote.

Patients taking rofecoxib had an increase in risk of death after taking the drug for a week to two weeks, while the other selective COX-2 inhibitor, celecoxib (Celebrex) had an increased risk of death when treatment lasted two weeks to a month.

Diclofenac "was associated with an increased risk from the beginning of treatment and the risk persisted throughout the course of treatment."

For ibuprofen, which was the most commonly used NSAID, the increased risk was seen for treatment lasting more than a week.

Among the findings: Cataflam(HR 1.45, 95% CI 1.29 to 1.62).

Naproxen increase the risk of death or recurrent MI by 76% after a week (HR 1.76, 95% CI 1.04 to 2.98), but for treatments lasting 30 to 90 days the risk increased risk was 15% (HR 1.15, 95% CI 0.80 to 1.65).

Ibuprofen had the lowest initial risk, just a 4% increase for treatments lasting seven days or less (HR 1.04, 95% CI 0.83 to 1.30).

The authors noted a number of limitations of the study, starting with its observational design.

Moreover, they noted that they were not able to determine the "precise indication for initiation of NSAID treatment. Thus, the disease or pain causing a condition treated with an NSAID could alone indicate a condition with increased risk of cardiovascular disease or death."

Information bias was another potential limitation as "patients do not necessarily take their medications consecutively, leading to the fact that the prescription may run longer and the patients therefore are exposed later than the database might indicate."

The authors said that more randomized clinical trials are warranted but, meanwhile, "the accumulating evidence suggests that we must limit NSAID use to the absolute minimum in patients with established cardiovascular disease."

The authors had no disclosures.

Take the Posttest Primary source: Circulation

Source reference: Schjerning Olsen AM, et al "Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction in patients with prior myocardial infarction a nationwide cohort study" Circulation 2011; DOI:10.1161/CIRCULATIONAHA.110.004671.

Sent via BlackBerry by AT & T

------------------------------------

[Guest guest]

So this means anyone with a history of heart attack

that takes NSAID drugs listed below has an increased risk of

death, up to 45 percent for some drugs and it gets worse the

longer the drug(s) are used. Wow, so I would speculate that if you

are liable to have a heart attack but haven't then I would worry

too.

http://en.wikipedia.org/wiki/Non-steroidal_anti-inflammatory_drug

Salicylates

Aspirin

(acetylsalicylic

acid)

Diflunisal

Salsalate

Propionic acid derivatives

Ibuprofen[33]

Naproxen

Fenoprofen

Ketoprofen

Flurbiprofen

Oxaprozin

Loxoprofen

Acetic acid derivatives

Indomethacin

Sulindac

Etodolac

Ketorolac

Diclofenac (Safety alert by FDA[34])

Nabumetone

Enolic acid (Oxicam)

derivatives

Piroxicam

Meloxicam

Tenoxicam

Droxicam

Lornoxicam

Isoxicam

Fenamic acid

derivatives ( Fenamates )

Mefenamic acid

Meclofenamic acid

Flufenamic acid

Tolfenamic acid

Selective COX-2

inhibitors (ibs)

Celecoxib (FDA alert[35])

Rofecoxib (withdrawn from market[36])

Valdecoxib (withdrawn from market[37])

Parecoxib FDA withdrawn, licenced in the

EU

Lumiracoxib TGA cancelled registration

Etoricoxib FDA withdrawn, licenced in

the EU

Firocoxib used in dogs and horses

Sulphonanilides

Nimesulide (systemic preparations are

banned by several countries for the potential risk of

hepatotoxicity)

Others

Licofelone acts by inhibiting LOX

(lipooxygenase) & COX and hence known as 5-LOX/COX inhibitor

On 5/11/2011 5:42 AM, nandtbearden@... wrote:

myocardial infarction

[Guest guest]

So this means anyone with a history of heart attack

that takes NSAID drugs listed below has an increased risk of

death, up to 45 percent for some drugs and it gets worse the

longer the drug(s) are used. Wow, so I would speculate that if you

are liable to have a heart attack but haven't then I would worry

too.

http://en.wikipedia.org/wiki/Non-steroidal_anti-inflammatory_drug

Salicylates

Aspirin

(acetylsalicylic

acid)

Diflunisal

Salsalate

Propionic acid derivatives

Ibuprofen[33]

Naproxen

Fenoprofen

Ketoprofen

Flurbiprofen

Oxaprozin

Loxoprofen

Acetic acid derivatives

Indomethacin

Sulindac

Etodolac

Ketorolac

Diclofenac (Safety alert by FDA[34])

Nabumetone

Enolic acid (Oxicam)

derivatives

Piroxicam

Meloxicam

Tenoxicam

Droxicam

Lornoxicam

Isoxicam

Fenamic acid

derivatives ( Fenamates )

Mefenamic acid

Meclofenamic acid

Flufenamic acid

Tolfenamic acid

Selective COX-2

inhibitors (ibs)

Celecoxib (FDA alert[35])

Rofecoxib (withdrawn from market[36])

Valdecoxib (withdrawn from market[37])

Parecoxib FDA withdrawn, licenced in the

EU

Lumiracoxib TGA cancelled registration

Etoricoxib FDA withdrawn, licenced in

the EU

Firocoxib used in dogs and horses

Sulphonanilides

Nimesulide (systemic preparations are

banned by several countries for the potential risk of

hepatotoxicity)

Others

Licofelone acts by inhibiting LOX

(lipooxygenase) & COX and hence known as 5-LOX/COX inhibitor

On 5/11/2011 5:42 AM, nandtbearden@... wrote:

myocardial infarction

[Guest guest]

So this means anyone with a history of heart attack

that takes NSAID drugs listed below has an increased risk of

death, up to 45 percent for some drugs and it gets worse the

longer the drug(s) are used. Wow, so I would speculate that if you

are liable to have a heart attack but haven't then I would worry

too.

http://en.wikipedia.org/wiki/Non-steroidal_anti-inflammatory_drug

Salicylates

Aspirin

(acetylsalicylic

acid)

Diflunisal

Salsalate

Propionic acid derivatives

Ibuprofen[33]

Naproxen

Fenoprofen

Ketoprofen

Flurbiprofen

Oxaprozin

Loxoprofen

Acetic acid derivatives

Indomethacin

Sulindac

Etodolac

Ketorolac

Diclofenac (Safety alert by FDA[34])

Nabumetone

Enolic acid (Oxicam)

derivatives

Piroxicam

Meloxicam

Tenoxicam

Droxicam

Lornoxicam

Isoxicam

Fenamic acid

derivatives ( Fenamates )

Mefenamic acid

Meclofenamic acid

Flufenamic acid

Tolfenamic acid

Selective COX-2

inhibitors (ibs)

Celecoxib (FDA alert[35])

Rofecoxib (withdrawn from market[36])

Valdecoxib (withdrawn from market[37])

Parecoxib FDA withdrawn, licenced in the

EU

Lumiracoxib TGA cancelled registration

Etoricoxib FDA withdrawn, licenced in

the EU

Firocoxib used in dogs and horses

Sulphonanilides

Nimesulide (systemic preparations are

banned by several countries for the potential risk of

hepatotoxicity)

Others

Licofelone acts by inhibiting LOX

(lipooxygenase) & COX and hence known as 5-LOX/COX inhibitor

On 5/11/2011 5:42 AM, nandtbearden@... wrote:

myocardial infarction

[Guest guest]

So this means anyone with a history of heart attack

that takes NSAID drugs listed below has an increased risk of

death, up to 45 percent for some drugs and it gets worse the

longer the drug(s) are used. Wow, so I would speculate that if you

are liable to have a heart attack but haven't then I would worry

too.

http://en.wikipedia.org/wiki/Non-steroidal_anti-inflammatory_drug

Salicylates

Aspirin

(acetylsalicylic

acid)

Diflunisal

Salsalate

Propionic acid derivatives

Ibuprofen[33]

Naproxen

Fenoprofen

Ketoprofen

Flurbiprofen

Oxaprozin

Loxoprofen

Acetic acid derivatives

Indomethacin

Sulindac

Etodolac

Ketorolac

Diclofenac (Safety alert by FDA[34])

Nabumetone

Enolic acid (Oxicam)

derivatives

Piroxicam

Meloxicam

Tenoxicam

Droxicam

Lornoxicam

Isoxicam

Fenamic acid

derivatives ( Fenamates )

Mefenamic acid

Meclofenamic acid

Flufenamic acid

Tolfenamic acid

Selective COX-2

inhibitors (ibs)

Celecoxib (FDA alert[35])

Rofecoxib (withdrawn from market[36])

Valdecoxib (withdrawn from market[37])

Parecoxib FDA withdrawn, licenced in the

EU

Lumiracoxib TGA cancelled registration

Etoricoxib FDA withdrawn, licenced in

the EU

Firocoxib used in dogs and horses

Sulphonanilides

Nimesulide (systemic preparations are

banned by several countries for the potential risk of

hepatotoxicity)

Others

Licofelone acts by inhibiting LOX

(lipooxygenase) & COX and hence known as 5-LOX/COX inhibitor

On 5/11/2011 5:42 AM, nandtbearden@... wrote:

myocardial infarction