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Common painkiller linked to increased risk of major heart problems

The Kashmir Monitor

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The commonly used painkiller diclofenac is associated with an increased risk of major cardiovascular events, such as heart attack and stroke, compared with no use, paracetamol use, and use of other traditional painkillers, finds a study published by The BMJ this week.
The findings prompt the researchers to say that diclofenac should not be available over the counter, and when prescribed, should be accompanied by an appropriate front package warning about its potential risks, medicalxpress.com reported.
Diclofenac is a traditional non-steroidal anti-inflammatory drug (NSAID) for treating pain and inflammation and is widely used across the world.
But its cardiovascular risks compared with those of other traditional NSAIDs have never been examined in large randomized controlled trials, and current concerns about these risks make such trials unethical to conduct.
So a research team, led by Morten Schmidt at Aarhus University Hospital in Denmark, examined the cardiovascular risks of starting diclofenac compared with no NSAIDS, starting other traditional NSAIDs, and starting paracetamol.
The results are based on national registry data for more than 6.3 million adults in Denmark with at least one year of continuous prescription records before study entry in January 1996.
Participants were split into low, moderate, and high baseline cardiovascular risk. Average age was 46-49 years among participants starting NSAIDs and 56 years among those starting paracetamol.
After taking account of potentially influential factors, starting diclofenac during the study period (1996-2016) was associated with an increased rate of major adverse cardiovascular events within 30 days compared with starting other traditional NSAIDs (ibuprofen or naproxen) or starting paracetamol.
Events included irregular heart beat or flutter, ischaemic stroke, heart failure, and heart attack. The increased risks applied to men and women of all ages and also at low doses of diclofenac.
Starting diclofenac was also associated with an increased rate of cardiac death compared with no NSAIDs, and an increased risk of upper gastrointestinal bleeding compared with no NSAIDs, starting ibuprofen or paracetamol, but not with naproxen.
The authors point out that, although the relative risk was increased, the absolute risk remained low for the individual patient.
When results were analyzed by baseline cardiovascular risk, the absolute number of events per 1000 diclofenac starters per year also increased.
For example, among patients at low baseline risk, diclofenac starters had one additional event versus ibuprofen starters, one additional event versus naproxen starters, three additional events versus paracetamol starters, and four additional events versus no NSAIDs. Among patients at moderate baseline risk, corresponding figures were seven, seven, eight, and 14 additional events, respectively, and for those at high baseline risk, corresponding numbers were 16, 10, one, and 39 additional events, respectively.
This is an observational study, so no firm conclusions can be drawn about cause and effect. However, the study’s sample size is larger than most previous analyses of observational and randomized studies taken together and provides strong evidence to guide clinical decision making.
“Treatment of pain and inflammation with NSAIDs may be worthwhile for some patients to improve quality of life despite potential side effects,” they write. “Considering its cardiovascular and gastrointestinal risks, however, there is little justification to initiate diclofenac treatment before other traditional NSAIDs,” they concluded.


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Health

Beware of the silent killer

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By Dr Sudhir Koganti

One may wonder what all this fuss about high blood pressure is. Hypertension causes many cardiovascular diseases that include stroke, heart attack, kidney failure and dementia, thus putting a huge burden on healthcare globally due to morbidity, mortality and associated costs. Last but not least, the public need to be aware of the correct treatment for high blood pressure.
Every year, the World Hypertension Day is celebrated on the 17th of May to increase awareness about this silent killer among general public. International Society of Hypertension along with World Hypertension League has designated the month of May as “May Measurement Month.”
The aim of this initiative is to screen as many people as possible that are over the age of 18 years for suspected hypertension. This strategy would greatly enhance in identifying silent or undiagnosed hypertensives so that they can be targeted with guideline directed lifestyle, dietary advice and treatment.
Awareness on the lower threshold of blood pressure reading required to label an individual as hypertensive is also required. American Heart Association guidelines released in 2017 clearly stipulate that a blood pressure reading of over 130/80 is now considered as stage 1 hypertension. However, the job of a cardiologist doesn’t stop with diagnosis but actually starts there. Once someone is labelled as hypertensive, it needs to be established if it is true or an entity called white coat hypertension.
Furthermore, investigations may have to be carried out to see if hypertension is secondary to a cause. Once diagnosed, a decision needs to be taken if lifestyle modification can be adopted or treatment needs to be initiated early.
Lifestyle modifications include six key steps and they are:
• Get expert advice from your doctor to help you understand your results;
• Lower salt/sodium to prevent excess fluid in the blood, which strains blood vessels;
• Eat more fruits and veggies – particularly potassium-rich ones – to balance out sodium in the blood;
• Exercise – it makes the heart stronger, putting less strain on blood vessels;
• Quit smoking – constituents of tobacco smoke damages blood vessel linings; and
• Monitor your blood pressure at home
As per studies and data, thousands of people are on wrong treatment for hypertension with a class of drugs called Betablockers (Atenolol, Metoprolol etc) being prescribed as first line or second line agent.
Betablockers have been phased out as first line or second line drugs to treat hypertension a while ago, unless there is concomitant coronary artery disease or heart failure. In fact, the same holds for other concomitant conditions too such as kidney disease, stroke etc.
Essentially, the key message is one prescription does not fit all and it need to be tailored to the individual in a dedicated specialist clinic. People need to actively undergo blood pressure screening of themselves.
They need to nudge their relatives and friends in the month of May and seek expert advice on how to manage and monitor this silent killer over the long run to lead an active and healthy life. (Writer is Consultant Cardiologist, Citizens Hospitals, Nallagandla, Serilingampally)
Dr Sudhir Koganti

 
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Jawless fish may hold key to effective brain cancer treatment

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A chemical found in jawless parasitic fish can be used to deliver anti-cancer drugs directly to brain tumours, as well as lead to more effective treatments for trauma and stroke, a study has found.
The research, published in the journal Science Advances, found that molecules from the immune system of the parasitic sea lamprey may also be combined with a wide array of other therapies, offering hope to treat disorders like multiple sclerosis, Alzheimer’s disease or even traumatic injuries.
“We believe it could be applied as a platform technology across multiple conditions,” said Eric Shusta, a professor at the University of Wisconsin-Madison in the US.
When injected into the bloodstream, many drugs cannot reach targets in the brain as the blood-brain barrier prevents large molecules from leaving the blood vessels in the brain, researchers said.
In conditions such as brain cancer, stroke, trauma and multiple sclerosis, however, the barrier becomes leaky in and around the disease locations, researchers said.
The study found that leaky barrier offers a unique point of entry, allowing molecules to access the brain and deliver drugs precisely on target.
“Molecules like this normally couldn’t ferry cargo into the brain, but anywhere there’s a blood-brain barrier disruption, they can deliver drugs right to the site of pathology,” Shusta said in a statement.
Researchers said that the technology takes advantage of the fact that many diseases disrupt body’s natural defense mechanism – the blood-brain barrier, which lines the blood vessels of the central nervous system, protecting the brain from circulating toxins or pathogens.
They also linked the molecules to a chemotherapy called doxorubicin. The treatment prolonged survival in mouse models of glioblastoma, an incurable cancer.
“This could be a way to hold therapies in place that don’t otherwise accumulate well in the brain so they can be more effective,” said Ben Umlauf from the University of Wisconsin-Madison.
“There are several disease processes that disrupt the blood-brain barrier and we could conceive of delivering a variety of different therapies with these molecules,” said John Kuo from the University of Texas in the US.

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Life expectancy linked to a person’s walking speed

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People who walk slowly have a lower life expectancy than those who walk fast, a recent study has claimed. According to the study published in the Journal of Mayo Clinic Proceedings, those with a habitually fast walking pace have a long life expectancy across all levels of weight status – from underweight to morbidly obese.
Underweight individuals with a slow walking pace had the lowest life expectancy (an average of 64.8 years for men, 72.4 years for women). The same pattern of results was found for waist circumference measurements.
Professor Tom Yates, the lead author of the study, said, “Our findings could help clarify the relative importance of physical fitness compared to body weight on the life expectancy of individuals. In other words, the findings suggest that perhaps physical fitness is a better indicator of life expectancy than body mass index (BMI) and that encouraging the population to engage in brisk walking may add years to their lives.”
Dr Francesco Zaccardi, co-author of the study, said, “Studies published so far have mainly shown the impact of body weight and physical fitness on mortality in terms of relative risk, for example, a 20 per cent relative increase of risk of death for every 5 kilograms per metres squared increase, compared to a reference value of a BMI of 25 kilograms per metres squared (the threshold BMI between normal weight and overweight).”
Last year, Professor Yates and his team showed that middle-aged people who reported that they are slow walkers were at higher risk of heart-related disease compared to the general population.

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