Dr. Joseph Mercola
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How Vioxx and Celebrex Increase Your Risk of Heart Attack
=========================================================
Research in mice suggests that a newer class of painkilling drugs
called COX-2 inhibitors could trigger a chain of events potentially
harmful to the cardiovascular system.
Researchers speculate, though, that their findings might explain the
outcome of a recent major trial in which patients taking a COX-2
inhibitor -- the arthritis drug Vioxx -- had higher rates of heart
attack and other cardiovascular complications compared with patients
on naproxen.
Naproxen, used in painkillers such as Aleve, belongs to a group of
drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs), which
includes many familiar painkillers such as aspirin and ibuprofen.
Aspirin is also well known for its heart-healthy blood-thinning
effects.
COX-2 inhibitors -- which besides Vioxx include the arthritis drugs
Celebrex, among others -- are a newer type of NSAID shown to be easier
on the stomach. Unlike older forms such as aspirin, they work by
selectively blocking the COX-2 enzyme. Traditional NSAIDs inhibit both
the COX-2 and COX-1 enzymes, and this is believed to underlie the
gastrointestinal side effects that can come with the drugs.
But the new mouse research suggests that the selectivity of COX-2
inhibitors could create an imbalance that promotes blood clotting and
blood vessel constriction.
COX-1 makes thromboxane A2, which promotes blood vessel constriction
and "stickiness" in blood cells called platelets. COX-2 is the major
source of prostacyclin, which helps prevent platelets from clumping
and promotes blood vessel dilation.
The researchers hypothesized that the heart-healthy ways of
prostacyclin might counter the ill cardiovascular effects of
thromboxane A2 in the body -- meaning that blocking only COX-2, and
therefore prostacyclin, could allow thromboxane A2 to go about its
business unchecked.
The researchers found that mice without a PGI2 receptor -- which
mimics the clinical effect of taking COX-2 inhibitors -- had an
enhanced vascular response to injury and showed increased thromboxane
A2 formation and platelet activation. This exaggerated response was
canceled out in mice lacking both thromboxane A2 and PGI2 receptors
Recently Merck & Co. Inc., the maker of Vioxx, announced that the
arthritis drug's labeling would be changed to state that it carries
higher cardiovascular risks than naproxen -- a move required by the US
Food and Drug Administration following the Vioxx-naproxen trial.
However, that labeling also highlights data from two other studies
showing that Vioxx users had a lower rate of cardiovascular problems
compared with study participants taking an inactive placebo, although
the difference was not statistically significant.
Science April 19, 2002;296:539-541
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Dr. Mercola's Comment:
Folks, I announced this warning in January 1999, over three years ago
when it was first published by the National Academy of Sciences. That
is one of the benefits you receive by reading this newsletter. You
will find out the medical facts that will be making headlines in the
future.
The market for analgesics is about TEN BILLION dollars per year. That
is one big number. That is why these are important drugs to watch. It
is important to remember that anytime you are dealing with numbers
that large there will inevitably be corruption, greed and negative
influences that are a part of the story if drugs are involved.
Originally, these drugs were thought to decrease the risk of ulcers.
However, an FDA Advisory Panel has since found that these drugs do NOT
decrease one's risk of developing ulcers.
They also appear to be associated with an increase in damage to the
kidneys.
Now we find more evidence that, as I said in 1999, these drugs also
increase one's risk of heart disease. I do want to put the increased
heart attack risk in its proper perspective. Although they appear to
double the risk of heart disease, the overall risk is still quite low.
The drugs can likely still be used as a temporary measure while one is
working on the cause of the problem. If one is following the proper
eating plan, it is likely that the small increase in heart disease
will not occur due to the other changes that occur in one's
biochemistry due to eating properly. This is primarily related to
normalization of insulin levels that corrects thousands of chemical
pathways that would affect heart disease risk.
Additionaly, it is important to recognize that my revised eating plan
has a strong emphasis on omega-3 fats which influence the good
prostaglandins in your body. Prostaglandins are chemicals that you
body makes and can either promote or prevent inflammation.
In fact that is how Vioxx and Celebrex and all the other
anti-inflammatories like aspirin work. They impair the prostaglandin
pathways.
You can create your own anti-inflammatory just by changing the ratio
of omega-6 to omega-3 fats in your diet. Folks this is
non-controversial and there are dozens and dozens of studies which
clearly demonstrate this. Even traditional medicine has firmly
embraced these concepts.
I review many controversial topics, but there is no disagreement on
this one, virturally everyone acknowledges that omega-3 fats play a
crucial role in arthritis. If you need guidelines on how to use them
please review my comments on Dr. Connor's excellent article.
However, this story does demonstrate the dangers of using these drug
band-aids as a permanent "fix" for the problem. They may actually seem
to work, but they work at a huge price, both economically and
physically. Does one really want to trade joint pain for a heart
attack?
Having stated that, the pain in many conditions can be quite severe.
Fortunately there are simple basic solutions for over 95% of the
conditions that you would be taking these drugs for.
The first step, of course, is to follow the eating plan.
Next would be NST which works incredibly well for both osteoarthritis
(DJD) and rheumatoid arthritis (RA).
For severe rheumatoid arthritis I have found my revision of Dr.
Brown's protocol useful in producing remission in over 2,000 patients
with RA that I have cared for in the last 13 years.
Related Articles:
Celebrex and Vioxx Increase Heart Disease Risk
Common Anti-Inflammatory Can Cause Non-Bacterial Meningitis
Drug Company Lies About Celebrex in JAMA
COX-2 Drugs May Damage Kidneys
Celebrex Not Shown to Lower Ulcer Risk
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