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January 7th, 2013

AHA Adds Its Weight to NSAID Risk Message

AHA Adds Its Weight to NSAID Risk Message
MedPage Today
January 06, 2013

The American Heart Association (AHA) has joined the newly formed Alliance for the Rational Use of NSAIDs, a public health coalition that aims to bring more awareness to the health risks associated with nonsteroidal anti-inflammatory drugs (NSAIDs).

About 98 million NSAID prescriptions were filled in 2012 and about 23 million people in the U.S. use over-the-counter NSAIDs on a daily basis. But these drugs are not benign; they can harm the kidneys, gastrointestinal tract, and cardiovascular system.

For example, patients with a first heart attack who took NSAIDs had a 41% increased risk of a second heart attack that persisted out to 5 years, compared with similar patients who did not take NSAIDs, according to study published in Circulation in September.

A network meta-analysis of randomized trials published in BMJ in 2011 found that all NSAIDs carried a cardiovascular risk, but some were less harmful than others. In particular, naproxen had the lowest risk for myocardial infarction, while rofecoxib (Vioxx) topped the list. Rofecoxib was taken off the market in 2004.

"It's very important for the American Heart Association to have joined the Alliance for the Rational Use of NSAIDs since the individuals who are at risk are just the patients we care for," Elliott Antman, MD, associate dean for clinical translation research at Harvard Medical School and a spokesperson for the AHA, told MedPage Today.

In 2007, the AHA published an update for clinicians on the use of NSAIDs. The key message of the scientific statement was for clinicians to use an NSAID that is "associated with the least risk -- from a cardiovascular perspective -- in the lowest dose that is needed to treat the patient's pain over the shortest period of time," Antman said.

The scientific statement noted that the evidence at that time indicated that selective COX-2 inhibitors (celecoxib [Celebrex], for example) have adverse cardiovascular effects that include increased risk for myocardial infarction, stroke, heart failure, and hypertension. The risk is greatest in those with a prior history of cardiovascular disease or in those already at high risk for heart disease.

"Many patients don't realize there is the potential for adverse events associated with NSAIDs," Jennifer Wagner, LPN, ASN, executive director of the Western Pain Society, the founding member of the Alliance, told MedPage Today. "In particular, people can get into trouble when they unknowingly combine NSAIDs, such as an over-the-counter flu medication, on top of a known NSAID."

The scrutiny given to prescription opioid pain medications over the last several years has meant that many pain patients have increased their use of NSAIDs, which is what drew Wagner's attention to the risks associated with NSAID use.

"Given the number and statistics, it's a pretty significant health issue," said Wagner, director of clinical research at Pain Research of Oregon.

The ultimate mission of the Alliance is to maximize the benefits of NSAIDs while reducing the risks, but there are three actionable goals the Alliance is committed to, Wagner said:

Bridging the gap between clinical guidelines and clinical practice
Encouraging healthcare providers to have open and ongoing dialog about NSAIDs with their patients
Informing patients that they can take charge of their own healthcare around this issue

Other organizations that belong to the Alliance include the American Academy of Nurse Practitioners, the American Academy of Physician Assistants, the National Kidney Foundation, the American Chronic Pain Association, and the American Association of Colleges of Pharmacy.

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