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CMHC PULSE

Cardio Metabolic Health Congress – Official Blog

The Risk of Heart Disease with Painkillers

A large-scale study conducted in 2017 originally indicated that common painkillers like ibuprofen and naproxen are considered risky for people who have had heart attacks; additional research has demonstrated that the risk can begin within the first week of usage.

The initial study involved NSAIDs: non-steroidal anti-inflammatory drugs, including ibuprofen—generically known under its brand names Advil and/or Motrin. Researchers at McGill University pooled extensive studies and clinical research on NSAIDs and heart attacks, using a data pool of over 446,000 people who used the drugs, including 385,000 participants who did not have heart attacks.

The report, published in the British Medical Journal, stated that current use of a NSAID is “associated with a significantly increased risk of acute myocardial infarction,” the medical terminology for a heart attack. Moreover, the risk began within a week of usage. The data demonstrated that those who used NSAIDs were more likely to have a repeat heart attack, or die within the next 5 years. In the first year post-heart attack, 20 percent of NSAID users died, compared to approximately 12 percent of non-users. The death rate of NSAID users remained about double than that of non-users in the next few years.

A number of studies have consistently revealed similar patterns concerning NSAIDs and heart disease, coupled with biological reasons that NSAIDs could be risky for people with heart disease. Evidence suggests that the drugs may impact and affect blood clotting, blood vessel function, and blood pressure. Because NSAIDs are available over the counter, many patients and consumers believe that there is no inherent danger involved.

The U.S. Food and Drug Administration has already added ‘black box warnings’ to NSAIDs, warning people with higher risks for heart disease and blood pressure to avoid using them without the recommendation of a physician. Dr. Gordan Tomaselli, chief of cardiology at Johns Hopkins University, advises: “if you’ve ever had a heart attack, you should use NSAIDs with caution.”

More recent research has indicated that for patients with osteoarthritis, NSAIDs increase the risk for cardiovascular disease to more than twice the rate of the general population. “There’s no cure for people with osteoarthritis, and you have to treat the pain. But when you treat it with NSAIDs, you increase cardiovascular risk,” said Aslam Anis, PhD, from the University of British Columbia in Vancouver, Canada.

African-Americans More Likely to Die From CVD

According to the American Heart Association, African Americans experience significantly worsened cardiovascular health, and thus face greater mortality rates from heart disease. African Americans die an average of 3.4 years before white Americans, a gap largely attributable to widespread cardiovascular disease and increased risk factors. Recent publication of a scientific statement from the organization reads: “The burden of cardiovascular disease in the African American community remains high and is a primary cause of disparities in life expectancy between African Americans and whites.” More recently, new research indicates that African-Americans suffer hypertensive crisis at a rate five times higher than the national average.

Dr. Mercedes R. Carnethon from Northwestern University Preventive Medicine in Chicago states that traditional cardiovascular risk factors—including high blood pressure, diabetes, obesity, and atherosclerosis—are not only more common among African Americans, but also manifest at relatively young ages. Data indicates that high blood pressure is diagnosed in 13.8 percent of black children, compared to 8.5 percent in white children. The risk of persisting hypertension in black adults, throughout adulthood, is 1.5 times higher than in whites. “Interrupting this process by preventing the early onset of cardiovascular diseases is one strategy to reduce disparities in cardiovascular disease mortality,” Dr. Carnethon writes.

The research team at the American Heart Association notes that circumstances have remained fairly stagnant since 2005; relatively little has changed since that year, when the same journal pointed to disparities in the rates of cardiovascular disease, disease management, and outcomes for African Americans. While genetic differences between African Americans and other groups do not account for the disparities in cardiovascular disease rates and outcomes, many of the variances arise from “unhealthy behaviors, lower implementation of guidelines shown to improve cardiovascular health, ingrained cultural preferences and attitudes, and lack of persistence in following lifestyle changes that need to be lifelong.”

While Dr. Carnethon’s team notes that cardiovascular disease is often preventable through the implementation and continued practice of a healthy, nutritious lifestyle, she discusses the inherent difficulties faced by many African Americans—particularly those in lower income groups—in accessing the necessary resources to lead healthy lifestyles: specifically, access to healthful foods, safe spaces for physical activity and exercise, and homes that allow for restorative sleep. Moreover, she argues that despite the strides our country has made in broadening access to healthcare, many African-Americans are still unable to afford and prioritize preventive care visits.

Dr. LaPrincess Brewer from the Mayo Clinic in Rochester, Minnesota has continuously worked to promote cardiovascular health in African-American communities, promotes “culturally relevant, community-based cardiovascular health interventions that focus more on positive motivation towards promoting cardiovascular health rather than the negative impact of cardiovascular disease.” Through increased awareness, and a collective, collaborative effort on the part of clinicians, public health workers, researchers, social services, and community stakeholders, the high burden of traditional risk factors among African Americans can be addressed—in tandem with the intrinsic social and environmental contextual barriers faced by this specific population.

At the upcoming 13th Annual CMHC, the CME Breakfast Symposium “The ABC Access Program: Overcoming Barriers to Access of Newer Cardiovascular Agents for High-Risk and Minority” will focus on the challenges faced by high-risk and minority patients. Hosted in partnership with the Association of Black Cardiologists, Inc., this session will highlight ongoing initiatives to overcoming barriers to access, and provide best practices for applying solutions to real-world clinical scenarios.