Rapids Beats: Heart Disease News and Updates for October

October 2016

Pill bottles

Nine Pain Killers May Raise the Risk of Heart Failure Hospitalization

Non-steroidal anti-inflammatory drugs (NSAIDs), drugs widely used to treat pain, are thought to increase the risk of heart failure in some patients. A new study has found that several prescribed NSAIDs are associated with a significantly increased risk of hospital admission for heart failure in the two weeks after use, but that the increase in risk can vary greatly depending on the drug in question and the sex of the individual.

For five of these drugs (diclofenac, etoricoxib, indomethacin, piroxicam, and rofecoxib), very high doses raised the risk of hospitalization for heart failure by more than twofold. These risks were the same whether or not people had been previously diagnosed with the disease.

NSAIDs Associated with Increased Risk of Hospital Admission for Heart Failure (Odds ratio)

In Men
(in descending order of risk)

In Women
(in descending order of risk)

Ketoralac (Toradol®) (1.86)

Ketoralac (Toradol®) (1.96)

Etoricoxib (Arcoxia®) (1.80)

Etoricoxib (Arcoxia®) (1.45)

Indomethacin (Indocin®, Tivorbex®) (1.71)

Rofecoxib (Vioxx®) (1.37)

Rofecoxib (Vioxx®) (1.35)

Piroxicam (Feldene®) (1.31)

Piroxicam (Feldene®) (1.34)

Indomethacin (Indocin®, Tivorbex®) (1.25)

Nimesulide* (1.31)

Diclofenac (e.g., Voltaren®, Cataflam®) (1.19)

Naproxen (e.g., Aleve®) (1.24)

Nimesulide* (1.17)

Diclofenac (e.g., Voltaren®, Cataflam®) (1.21)

Ibuprofen (e.g., Advil®, Motrin®) (1.16)

Ibuprofen (e.g., Advil®, Motrin®) (1.18)

Naproxen (e.g., Aleve®) (1.15)

* Not approved for use in Canada

The study looked specifically at prescribed NSAIDs, not over-the-counter use. The analysis showed associations between the drugs and hospitalizations but could not show cause and effect. In addition, the researchers only looked at the odds of this increased risk. They could not calculate the actual number of hospitalizations for heart failure that might result from NSAID use.

A clinical trial examining the safety of three NSAIDs in patients with or at high risk of heart disease is expected to release its first results in November.

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Mortality Gap Closes Between Younger Men and Women with Acute Coronary Syndrome

In good news from data drawn from 26 hospitals across Canada, the United States and Switzerland, women younger than 55 with acute coronary syndrome (ACS) admitted to hospital between 2009 and 2013 were no more likely to die over the next year than men in the same age group.

For more than three decades, cardiovascular disease has killed more women than men in North America. Recently, significant attention has been brought to the fact that risk, symptoms, optimal treatment and other aspects of heart disease can differ between men and women, and that the medical establishment needs to both be aware of gender differences and work to eliminate disparities in outcomes.

In the new study, young women and men had similar rates of major adverse cardiac events. Though women were more likely than men to be readmitted to the hospital in the year following their cardiac event, no difference was seen between men and women in re-admissions specifically for heart disease.

The results from this study “may indicate that practices in younger ACS adults have improved,” said Louise Pilote, MD, PhD, of McGill University, who leads the project that gathered the data.

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Calcium Supplements and Dietary Calcium Are Not Created Equal

Though a diet naturally high in calcium may prevent plaque buildup in the arteries, the same cannot be said for calcium supplements. According to a new study out of Johns Hopkins University, these supplements may actually increase the risk of heart disease.

A team of researchers looked at data collected from 2,742 participants aged 45 to 84 in the Multi-Ethnic Study of Atherosclerosis who had two CT scans of the heart taken approximately 10 years apart. Patients who had the highest dietary calcium intake—including dairy products, leafy greens and calcium-enriched cereals—were on average 27% less likely than those with the lowest calcium intake to have worsening atherosclerosis over the ensuing decade.

On the other hand, calcium supplement users, who made up about half the study group, had a 22% increased risk of having their level of coronary artery calcification rise during the same period of time. The study could only show an association between calcium intake and heart disease risk, not cause and effect.

The issue of how calcium intake impacts heart disease remains a moving target. In the 1990s, calcium supplements and antacids such as Tums® were promoted for bone health. Then evidence of potential cardiovascular harm began to appear. However, some studies have since shown no association between supplement use and heart disease.

For now, “patients should really discuss any plan to take calcium supplements with their doctor to sort out a proper dosage or whether they even need them,” said Erin Michos, MD, of the Johns Hopkins University School of Medicine, in a press release that accompanied the new study.

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