Popular Pain Relievers Trigger Heart Attacks!

Miners used to take a canary with them into the coal mine because if the bird died, the air had gone bad and it was time to get out of the mine. Heart attack patients are like those canaries. They are more vulnerable than healthy people to cardiac events, so they serve as an early warning system for heart risks. These heart attack survivors have just sent out a big alert about the dangers of pain relievers!

Danish researchers identified nearly 100,000 patients over the age of 30 who had experienced a first-time heart attack sometime between 1997 and 2009. They were followed for up to 5 years after their initial heart attacks (Circulation, online, Sept 10, 2012). The scientists were especially interested in the post-heart attack use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as:

• Celecoxib (Celebrex)

• Ibuprofen (Advil, Motrin, etc)

• Diclofenac (Cataflam, Voltaren)

• Naproxen (Aleve, Naprosyn)

• Rofecoxib (Vioxx)

It should come as no surprise that heart attack patients, like the general population, take a lot of pain relievers. Because the Danish health care system reimburses medication expenses, all pharmacies keep records of dispensed prescriptions. That enabled these investigators to track prescribed NSAID use. Of the 99,187 patients in the study, nearly half (44%) filled a prescription for one of the pain relievers above.

And the envelope, please: It turns out that the heart attack survivors who took an NSAID-type pain reliever were at a substantially higher risk of having another heart attack or dying than those patients who did not take such drugs. In their first year following a heart attack, about one-fifth of the NSAID users died, compared to 12 percent of those not taking an NSAID-type pain reliever. Over the five years of the study, NSAID users were about twice as likely to die as non-users. They were also at increased risk for another heart attack. The investigators concluded:

"It would seem prudent to limit NSAID use among patients with cardiovascular disease and to get the message out to clinicians taking care of these patients that NSAIDs are potentially harmful, even 5 years after MI [myocardial infarction or heart attack]."

We would take this warning a step farther. As we stated at the beginning, heart attack patients are like canaries in the coal mine because they are more susceptible to repeat heart attacks. They also serve as a warning to the rest of us. Heart attack survivors may be more vulnerable, but we're all at risk and they have just put up a huge red flag.

Ever since the great Vioxx scandal, there has been a growing recognition that most NSAIDs (except for aspirin) may pose a risk of heart attacks and strokes for the population at large--not just heart attack survivors. That's because these drugs can increase blood pressure, affect blood vessel physiology and alter blood clotting. All these factors could be responsible for a greater susceptibility to blood clots that could cause heart attacks and strokes. This discovery has pretty much disappeared without a trace, however. Most people (including doctors) have ignored the warning.

The authors of the new article in Circulation note that doctors are prescribing NSAIDs to a vulnerable population in worrisome amounts (44% of the heart attack victims got a prescription for such drugs). The investigators also expressed concern that despite widespread knowledge about the risks of such drugs, some NSAIDs (ibuprofen and naproxen) are available without a prescription. By the way, naproxen (Aleve) appears to be a little less likely than other NSAIDs to cause cardiovascular complications but it has been associated with gastrointestinal bleeding, a complication of all NSAIDs.

Here's the straight and skinny:

NSAIDs, whether prescription or over-the-counter, pose some serious risks, including heart attacks, strokes, bleeding ulcers or death. Other side effects include:

NSAID SIDE EFFECTS

• Heartburn, indigestion, abdominal pain, nausea, constipation

• Headache, dizziness, drowsiness, disorientation

• Skin rash, sensitivity to sunlight, itching (potentially serious, so notify the MD!)

• Fluid retention, edema, high blood pressure

• Heart failure

• Ringing in ears, hearing changes

• Visual disturbances

• Ulcers, bleeding ulcers, perforated ulcers

• Liver damage, kidney damage

• Blood disorders, anemia

• Worsening asthma symptoms

People swallow an extraordinary number of NSAIDs either because their doctor prescribes them or because they are readily available over-the-counter. Despite admonitions on the OTC label to take ibuprofen or naproxen for no longer than 10 days, many Americans take NSAIDs daily for weeks, months or years.

Only about one person out of five actually reads the directions on the label. Fewer than one in three checks out the dosing instructions. About one quarter take more than the recommended dose of OTC NSAIDs, and about half of the people in one survey did not realize that OTC pain relievers could cause any harm (Journal of Rheumatology, Nov. 2005).

Most people assume that if you can buy a drug without a prescription it must be safe. Nothing could be further from the truth, especially when it comes to NSAIDs. If you told people that the OTC pain reliever they are popping could cause a heart attack, stroke or death they would likely be surprised the FDA would permit such a thing. And if someone has a heart attack or dies while taking ibuprofen for a bad back, arthritis or a headache, chances are that the NSAID won't be considered a contributing cause of the tragedy.

What's a person to do if she has pain and does not want to risk the complications of an NSAID pain reliever? We offer dozens of non-drug options in our book, The People's Pharmacy Quick & Handy Home Remedies. Herbs such as boswellia (p. 149), spices such as cayenne (p. 150) or turmeric (p. 152), supplements such as fish oil (p.154) or vitamin D (p. 158) and foods such as grape juice with Certo (p. 157), honey and vinegar (p. 156), pineapple juice (p. 156) and tart cherries (p. 153) have all provided relief for some people with joint pain.

Incorporating anti-inflammatory foods into tasty recipes is another approach to managing pain relief while limiting side effects. In our book Recipes & Remedies From The People's Pharmacy, we offer instructions for remedies like cherry spritzer (p. 62), curcumin milk (p. 60), ginger pickle (p. 50), pineapple-cherry cocktail (p. 65), virgin raisins (p. 64) or anti-inflammatory curcumin scramble (p. 103). Adding fish to the diet in dishes such as favorite fish platter (p. 106), fish tacos with radish & lime (p. 120) horseradish-crusted salmon with cranberry catsup (p. 127), pescado al cilantro (p. 137) salmon with fava bean & spring pea mash (p. 141) or spicy fresh tuna salad (p. 143) puts anti-inflammatory power into everyday meals, and adds heart benefits rather than risks.

You can find all our books and guides in The People's Pharmacy Store. And please reconsider routine use of NSAIDs like ibuprofen, meloxicam, naproxen and diclofenac. Such drugs may ease pain a bit, but the list of side effects is scary. People who have had heart attacks are not the only ones at risk for serious, even life-threatening complications.

New DNA Mutations Discovered in Malignant Melanomas

The mutations, which may be the most common in melanoma cells, share genetic hallmarks with other ultraviolet light–induced mutations. Researchers at the Dana-Farber Cancer Institute and the Broad Institute of Harvard and MIT have found new genetic mutations that appear in a combined total of 71% of malignant melanomas. They reported their findings in the February 22, 2013, edition of Science.

 The mutations were found in the “dark matter” of the tumor—sometimes referred to as “junk” DNA—because this area does not encode for proteins. This is the first time scientists have found mutations in this area of the cancer genome. (Previously, cancer genes have only been discovered in the protein-encoding region of the genome.) However, researchers found that these might be the most common mutations in melanoma cells.

 The researchers discovered the mutations by sifting through whole-genome sequences of cells taken from malignant melanoma tumors. These mutations are present in other malignancies, especially hepatocellular and bladder cancers. The researchers noted that this result prompted them to look at cancer tumors’ entire genomes.

 Doing so in the melanoma tumors led the researchers to a region that regulates and controls telomerase reverse transcriptase (TERT), which signals to increase telomerase production. Telomerase, in turn, prolongs cell life by allowing indefinite cell division and circumventing apoptosis (programmed cell death). In melanoma, the researchers were also able to show that TERT mutations share genetic hallmarks with other ultraviolet light–induced mutations.

 TERT is expressed in 90% of cancers. The mechanism in other cancers may be the same as or similar to that identified in melanoma. TERT has been an elusive target for drug development, but this finding may renew interest and help researchers think outside the box and find new approaches.

Aspirin Vs. Cancer What Are We Waiting For

The latest research is in and it is really good news. Once again aspirin has been shown to reduce the risk of one of the deadliest cancers--melanoma--a skin cancer that is notoriously hard to treat.
The data came from the Women's Health Initiative (WHI), one of the most important research initiatives in memory. You may recall that it was the WHI that uncovered the sad truth about the risks of hormone replacement therapy (HRT). The study started in 1991 and followed over 160,000 postmenopausal women for at least 15 years. HRT in the form of Prempro (estrogens and progestin) increased the risk for heart attacks, strokes, blood clots and most worrisome of all, breast cancer.
Scientists have continued to track many of the women who were recruited into the WHI. The latest research focused on the likelihood of developing melanoma in nearly 60,000 Caucasion women who participated in this program. They were tracked for 12 years. Those who took a standard aspirin tablet at least twice a week reduced their risk of developing melanoma by 21 percent. Women who regularly relied on aspirin for at least five years decreased their likelihood of being diagnosed with melanoma by 30 percent.
The lead investigator of the study, Dr. Jean Tang at Stanford University School of Medicine told NPR, that "In terms of cancer prevention, a lower melanoma risk by 20 percent is very large and significant... There's nothing else that I know of that has as large an effect as what we're seeing with aspirin."
Despite this long-term study's positive results there are a lot of naysayers when it comes to aspirin vs. cancer. Some point out that this was not a randomized, double-blind, placebo-controlled trial. It was "only" an observational study, meaning that the investigators compared self-reported aspirin users with women who said that they used NSAID (ibuprofen or naproxen) pain relievers or acetaminophen.
The gold standard would have been a study in which women were randomized to take aspirin, placebo, NSAIDs or acetaminophen. They would have been tracked for years to see whether there was a difference in outcome. The only problem is that such a study will never be conducted because it would cost too much and our government is not likely to come up with the hundreds of millions such a study would require. No drug company would sponsor such a study since aspirin is dirt cheap and available generically.
If this were the only study suggesting that aspirin might be beneficial in preventing hard-to-treat cancers, we too might be a bit cautious. But this is not the first time we have seen a strong connection between the use of aspirin and a reduced risk of serious cancers.
Other studies have also found that aspirin use has been linked with a lower likelihood of developing squamous cell carcinoma of the skin as well as melanoma. A case-control study from China shows that women who took aspirin twice a week for at least a month were nearly 50 percent less likely to be diagnosed with lung cancer. That was among non-smokers. Among women who smoked, the reduction was 62 percent.
An aspirin study from the Netherlands suggests that aspirin may actually improve survival in patients with colon cancer. Almost 4,500 people were included in the study that spanned nearly a decade. Of these, almost one in four took aspirin after their cancer diagnosis. Half had already been taking aspirin before the diagnosis and continued taking their low-dose aspirin pill after beginning treatment. One quarter of the colon cancer patients did not take aspirin. The researchers found that taking a baby aspirin pill daily reduced the risk of dying from colon cancer by up to 30 percent over the course of the decade.
A report published in the Journal of the National Cancer Institute showed that people taking daily aspirin were 40% less likely to develop digestive tract cancers. Over 100,000 American senior citizens were tracked for 10 years.
A ten-year study of more than 300,000 individuals between 50 and 71 at the outset has demonstrated that aspirin use is associated with less liver cancer and even death from liver disease.
People who took non-aspirin anti-inflammatory drugs like ibuprofen and naproxen had a one-third lower likelihood of liver cancer, but were just as likely as people not taking pain relievers to die from liver disease. Those taking aspirin, on the other hand, had a 37 percent lower risk of liver cancer and cut their risk of dying from liver disease in half.
When researchers review lots of aspirin trials they come up with the same result over and over. An analysis involved more than 50 clinical trials designed to determine if aspirin could prevent heart attacks and strokes. Nearly 80,000 subjects were included, and those assigned to take aspirin had 15 percent fewer deaths from cancer. They also experienced protection from heart attacks and strokes.
Another analysis covered 17,000 participants taking 75 mg of aspirin in randomized controlled trials. In this group of people, aspirin reduced the risk of metastasis by about 36 percent. This inexpensive drug appears to offer protection against cancers of the esophagus, breast, lung and stomach as well as against colon cancer. The scientists also found that, although aspirin can increase the risk of internal bleeding, this danger tends to fade with time and does not outweigh the cancer-protection benefit.
Even with all this good news about aspirin vs. cancer, there are a lot of clinicians who cannot bring themselves to say that aspirin could be one of the most valuable anti-cancer drugs in history. They point out that aspirin causes digestive tract upset and can lead to bleeding ulcers and that can be a life-threatening situation. We do not disagree that aspirin can be dangerous for some people. And no one should undertake a life-long aspirin regimen without medical consultation. But cancer is also a life-threatening disease. The treatments for cancer are incredibly toxic, especially when compared to aspirin.
If aspirin reduces the risk of developing skin cancer (and in particular melanoma), breast cancer, colon cancer, rectal cancer, liver cancer, lung cancer, esophageal cancer, stomach cancer and goodness knows what other cancers, then we think it deserves serious consideration as a miracle medicine.

Traditional Armenian Garments(video)

A selection of beautiful Armenian traditional lady costumes. 

Photography by: Ilya Vartanian & Karen Adriano