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Painkillers linked to heart failure
Painkillers linked to heart failure -- Posted by EL on 05-28-04 10:36
http://www.theglobeandmail.com/servlet/ArticleNews/TPStory/LAC/20040528/HARTH28/TPHealth/
Painkillers linked to heart failure
There are 'definitely risks' in taking some common arthritis drugs, Canadian
researchers say
Friday, May 28, 2004
People who take some commonly prescribed painkillers for arthritis are at
greater risk of developing congestive heart failure, new Canadian research
suggests.
The findings could have broad repercussions because one in four seniors
currently takes these drugs.
The bestseller, Vioxx, increased the risk of hospitalization for heart
failure by 80 per cent within one year of prescription.
Taking a non-steroidal anti-inflammatory drug, such as ibuprofen or
naproxen, increased the risk by about 10 per cent. Taking Celebrex, another
bestseller, did not increase the risk of hospitalization for heart failure,
researchers found.
However, among patients already suffering from heart failure, all the
painkillers increased risk substantially, suggesting they exacerbate
existing problems.
"The message we should retain is that there are definitely risks associated
with taking these drugs, along with the benefits," said Muhammad Mamdani, a
senior scientist at the Toronto-based Institute for Clinical Evaluative
Sciences, which conducted the study.
He said that, overall, only about 1 per cent of seniors taking these
painkillers are hospitalized for congestive heart failure each year, but
given the large number of patients treated, "these results are clinically
important and suggest a need for careful monitoring of the cardiovascular
effects on patients receiving them."
The findings were published in today's edition of the medical journal The
Lancet.
The principal drugs analyzed in this study, Vioxx and Celebrex, are among
the most successful and profitable prescription drugs in history. Launched
with much fanfare in 1999, they have largely displaced cheaper painkillers
used to treat arthritis, though they are only marginally more effective.
They are both cyclo-oxygenase-2 inhibitors, meaning they inhibit production
of cox-2, an enzyme involved in pain and inflammation. The non-steroidal
anti-inflammatory drugs do the same, but in a less specific manner. (The
study did not look at the effects of taking acetylsalicylic acid, or
Aspirin, for arthritis.)
The drugs also increase blood pressure, which is likely why the risk of
heart failure rises.
The main selling point of cox-2 inhibitors is that they cause fewer
gastrointestinal problems than the traditional anti-inflammatory drugs.
Dr. Mamdani said it is "really ironic" that patients may be trading one side
effect, gastric bleeding, for a far more serious one, congestive heart
failure. He also noted that the number of gastric bleeds and ulcers has
probably increased because so many more people are taking drugs to treat
arthritis than before the new drugs were launched.
About one in five people over the age of 65 takes cox-2 inhibitors, and
about one in three takes the traditional anti-inflammatory painkillers.
Based on the emerging evidence of risks, physicians and patients alike
should rethink this sort of ubiquitous use, said Dr. Mamdani, who is also an
assistant professor in the department of pharmacy at the University of
Toronto.
"While these drugs have been greeted with great enthusiasm, perhaps more
judicious prescribing by physicians is warranted," he said.
The researcher also recommended that arthritis sufferers "have a serious
discussion with their physician before considering these drugs,"
particularly if they have a history of cardiovascular disease or
gastrointestinal problems.
The new research is based on an analysis of patient records of almost 45,000
Ontario patients who were prescribed cox-2 inhibitors or non-steroidal
anti-inflammatory drugs between April, 2000, and March, 2001. They were
compared to 100,000 others who were not prescribed these drugs. The average
age of those in the study was 75, a population that has high rates of
osteoarthritis and heart failure.
There were 7.7 million prescriptions for cox-2 inhibitors in Canada last
year (including almost three million for Celebrex and 3.3 million for
Vioxx), with a total value of $475-million, according to IMS Health Canada,
a private company that tracks prescription-drug use. There were 16 million
prescriptions for the non-steroidal anti-inflammatories, with sales
totalling $305-million.
About four million Canadians suffer from arthritis. Approximately 350,000
have congestive heart failure.
Dr. Mamdani said earlier research helps explain why Vioxx users are more
likely to develop heart failure than Celebrex users. In head-to-head
comparisons, Vioxx raised blood pressure more than Celebrex. Vioxx also has
a longer half-life, meaning it stays in the body longer, and it has a
tendency to accumulate.
The researcher said patients should not stop taking their prescription drugs
based on this study. Rather, Dr. Mamdani said, if a person has concerns, the
matter should be discussed with his or her physician to determine the
personal risk and benefits from taking a particular drug.
**************************************************
Rick
lawrri@canada.com
**************************************************
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