Arthritis Medications Double Heart Attack Deaths

A recent British Medical Journal (BMJ) review [1] of studies including over 100,000 patients showed that NSAID medications (nonsteroidal anti-inflammatory drugs) used to treat arthritis dramatically increased heart attack death risk. Now another study, called the INVEST study [2], with over 22,000 patients has confirmed this problem.

Posted on | Jacob Teitelbaum, MD | Comments ()

A recent British Medical Journal (BMJ) review [1] of studies including over 100,000 patients showed that NSAID medications (nonsteroidal anti-inflammatory drugs) used to treat arthritis dramatically increased heart attack death risk. Now another study, called the INVEST study [2], with over 22,000 patients has confirmed this problem.

The good news? Natural herbal remedies may be just as effective as the medications – without the safety risks and at lower cost.

An Overview of the Problem

Many adults suffer from arthritis and other aches and pains. NSAID medications, such as ibuprofen, are in very common use. The use of these medications to treat arthritis increased after research showed that Vioxx increased heart attack risk (it was pulled from the market because of this). Unfortunately, this was like "jumping from the frying pan into the fire."

Research [3] has also shown that NSAID medications cause over 16,500 US deaths a year from bleeding ulcers. Added to a doubling of heart attacks/vascular disease (the number-one killer in the United States), and this is a big deal!

Now the INVEST study has shown that in adults who already have high blood pressure and heart disease, being on arthritis NSAID medications more than doubled their risk of heart attack.

However, it should be noted that these deaths are largely preventable. And you can be pain-free without the chronic use of medications.

FAQs

Should I stop the aspirin I'm taking for heart disease?

Absolutely not! For those with known heart disease, taking one aspirin a day is a very good idea and does not carry the same risks.

I've been on arthritis medicine for decades. Is the risk reversible?

Fortunately, although this needs to be studied further, the research we have suggests that the answer is yes. The risk can be reversed as the person comes off the medications. I say this because this same risk can occur with very short term use of ibuprofen immediately after a heart attack (within 37 days). This suggests that the heart attack risk is not increased by causing increased blockages in the arteries, but rather by changes in blood clotting and perhaps blood vessel spasm. These types of changes go away soon after the medication is stopped. So that is encouraging.

Should I stop the arthritis medication and just be in pain?

No, it is not healthy to be in pain.

Do not change any medications without your physician's approval. What you can do in the interim is to take simple measures to decrease your arthritis pain. That way, during your next visit, you can let your doctor know that the arthritis pain is much less and ask if you can stop the medications, using them only if needed. Let them know your concern based on the studies noted above, so they can explain to you why you still need the medication.

Here's what you can do to get pain free – without the medications.


1. Knowledge is power. Here’s a secret most physicians don’t know: Once arthritis pain has been treated for 3-4 months, and the pain settles down, the pain usually stays gone. It is like putting out a fire. Once the fire is put out, you can put away the fire extinguisher. This applies to both medications and natural remedies. Once a person has been on their arthritis treatments for 3-4 months, very often the medications and other treatments can simply be stopped, and then used on an as-needed basis. In the INVEST study, intermittent NSAID use did not carry the high risk of chronic use.

2. Natural remedies can be far more effective than medications. These include (but are not limited to):

  • Glucosamine sulfate, 750 mg, twice a week.
  • Willow bark (containing 120-240 mg of salicin equivalent a day)
  • Boswellia (more commonly known as the biblical herb frankincense), 1000-2000 mg a day. This dropped arthritis pain by an astounding 90% after just eight weeks in one arthritis study [4].
  • Curcumin (the yellow spice in Indian food found in turmeric). This herb has the added benefit of protecting against Alzheimer’s disease (Alzheimer’s is 2/3 less common in many parts of India than in the US). Curcumin is poorly absorbed unless it contains the essential oils, so I only use supplements that have the very highly absorbed BCM 95 form of curcumin.

All four of these can be taken together, and even along with your arthritis medication, though I find any one of the above to be as, or more, effective than the NSAID medications. After six weeks, you may find your arthritis is much improved.

3. Exercise: Walking is associated with a marked decrease in knee and hip pain.

4. Stretching: Reclaim your “range of motion.” Sometimes, flexibility decreases as arthritis pain limits your participation in activities. Stretching restores function. If it hurts when you stretch your fingers or other joints, a simple trick can help. Warm the joints with a hot compress, or one of the herbal microwave packs you can find online or in health food stores. After 5-10 minutes of warming, it will be much easier to stretch your joints.

Tight muscles all over? Take a soak in a hot Epsom salt bath. Simply add two cups of low-cost Epsom salts (magnesium salts; find them at your local supermarket or drug store) to your bath. Your muscles will soak in the magnesium, which is your body’s natural muscle and nervous system relaxer. While soaking, you can feel the pain and muscle tightness flowing right out of your body.  An added benefit? Magnesium helps protect the heart and improves heart function – making it a healthy and low-cost way to feel much better!


References

[1] "Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis."  Trelle S, Reichenbach S, Wandel S, Hildebrand P, Tschannen B, Villiger PM, et al. British Medical Journal 2010;341:c7086

[2] "Harmful Effects of NSAIDs among Patients with Hypertension and Coronary Artery Disease." Anthony A. Bavry, MD, MPH,a Asma Khaliq, MD,a Yan Gong, PhD,b Eileen M. Handberg, PhD, a Rhonda M. Cooper-DeHoff, PharmD, MS,a,b Carl J. Pepine, MDa, The American Journal of Medicine (2011) 124, 614-620

[3] "Recent Considerations in Nonsteroidal Anti-Inflammatory Drug Gastropathy." Singh Gurkirpal, MD, The American Journal of Medicine, July 27, 1998, p. 31S

[4] "Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee — a randomized double blind placebo controlled trial." Kimmatkar N, Thawani V, Hingorani L, et al., Phytomedicine, 2003;10(1):3-7.

Blog written by Jacob Teitelbaum, MD
Dr. Teitelbaum overcame Chronic Fatigue Syndrome and Fibromyalgia in 1975, and since then has helped hundreds of thousands...