Friday, July 15, 2011


Back to cardiology after the BERSIH postings. I just could not stand people not facing up to the truth.
There is a relevant paper published in the July issue of the American Journal of Medicine entitled "The harmful effects of NSAID amongst patients with hypertension and CAD". The lead author is Dr Anthony Bravry from the University of Florida, Gainsville. They did a post hoc analysis ( not the best way ) of the data from the large INVEST trial. The INVEST trial enrolled 22,000 patients. The main aim of INVEST was to compare the beneficial cardiac effects of controlling blood pressure with Verapramil ( CCB ) against Trandolipril ( ACE-I ), in patients who had hypertension and CAD. At each visit, with follow up of 2.7 years, the patients were asked, if they were taking NSAIDs regularly ( 882 patients ), intermittently ( 7,285 patients ) or never ( 14,408 patients ). After 2.7 years follow-up, they found that those who were taking NSAID had twice the CV events compared to those who never took. The intermittent takers were in between. The common NSAIDs were ibuprofen, naproxen and celecoxib. The study analysis could not separate as to which was more harmful. They all came out almost the same. They were taking the NSAIDs for a variety of conditions, including low backache, rheumatoid arthritis and osteoarthritis.
What then shall we do if our patients with CAD and HBP, should have chronic pain from osteoarthritis. I suppose, the easiest would be to add a low dose aspirin to the pain killer regime. However, one then have to worry about gastro-toxicity. Or, you could try and tail down the dose and frequency of the NSAIDs to lessen the CV risk. Of course, if paracetamol is adequate for pain control, that would be preferred.
As always, talk to the patient and discuss the CVS dangers of chronic NSAIDs, and have them understand it.

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