NSAIDs and Heart Risk

A study recently came out that I believe is important to share with anyone who may be reading. It deals with NSAID (non steroidal anti-inflammatory) treatment in people that have had a  heart attack (MI). The study can be accessed at the following link:

http://circ.ahajournals.org/content/early/2012/09/07/CIRCULATIONAHA.112.112607.full.pdf+html

It was a study done in Denmark that looked at patients who had MI’s and then used NSAIDS later on. They looked at things like Ibuprofen, Naproxen, Diclofenac as well as others such as Celecoxib (Celebrex) which is supposed to be friendlier to the heart than others. They looked at patients for up to 5 years after the initial or first MI. Here is what they found:

People who took any NSAID had a hazard ratio of 1.59 for death at 1 year. That means that people who took any NSAID after 1 year had 1.59 times the death rate than people who didn’t take any NSAID after an MI. After 5 years that ratio was 1.63, meaning 1.63 times the death rate of people who had none.

Diclofenac seemed to be the biggest offender with a hazard ratio of 2.36 after only 1 year and 2.07 after 5 years. Celebrex was 1.83 and 1.68 at 1 and 5 years respectively. Ibuprofen was 1.42 and 1.55 at years 1 and 5 respectively.

Naproxen seemed to be the least harmful at 1.7 at year 1 but 1.02 at year 5, and that was non-significant, meaning the difference between those with prior MI who weren’t taking naproxen had no different risk than those who were, at least for death.

Risk of coronary death or a subsequent MI was very similar to the mortality data with naproxen being the only drug with no significant difference after 2 years. Although the risk did appear to be reduced for some drugs

What does this all mean? The best thing I can say is that one should avoid NSAIDs if they have had an MI. Even short durations of treatment appear to be problematic as noted in the following study by the same authors as above.

http://circ.ahajournals.org/content/123/20/2226.full#ref-4

 It’s just not worth the risk of another MI or death in my opinion. All of this of course should be discussed with a competent medical professional. There are some cases where NSAID use might be the best course for another disease state but again, that should be discussed with a medical professional. I cannot emphasize enough the safe use of medication and right now it doesn’t look like NSAIDs are safe with previous MI even after 5 years. Take care when going to the supermarket or pharmacy and you feel some pain from that morning lifting session or jogging in the afternoon. Ice and heat is probably the better choice.

CIAO

The Brute

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.

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Eggs and Your Health

When I was a kid I remember seeing commercials for eggs and how they were “incredible and edible”. Obviously this was from egg producers trying to sell their product. I thought the ads were amusing and actually made me hungry for more eggs. I have always liked them. Basted or omelets or scrambeled with a little cheese …it didn’t matter. Hard boiled eggs were always fun at Easter time, not only from coloring them but from the deviled eggs that my mom or myself would make.  Back then eggs had been getting quite a bad rap during the anti-fat/cholesterol crusade. Since eggs have cholesterol and fat, proponents of the diet/heart hypothesis villified the friendly food as deadly and one that should be avoided at all costs because as we all know, cholesterol is the evil villain behind everything wrong with our current medical predicaments. (ok maybe too sarcastic)

Eggs have actually shown to have no real significant change on a cholesterol profile in many people, and those that do respond have an LDL/HDL ratio that doesn’t change. LDL/HDL ratio is a much better predictor of risk than just a total number. However it, at least in my opinion, is still trumped by personal family history and lifestyle (including diet, exercise, stress levels) Lets take a look at the nutrition component:

Nutrient Name %DV Nutrient Name %DV
Calories 4% Proteins 13%
Fat 8% Cholesterol 70%
Vitamin A 5% Vitamin D 4%
Vitamin E 2% Thiamin 2%
Riboflavin 14% Folate 6%
Vitamin B6 4% Vitamin B12 11%
Pantothenic Acid 7% Manganese 1%
Calcium 3% Iron 5%
Magnesium 2% Phosphorus 10%
Potassium 2% Sodium 3%
Zinc 4% Copper 3%
Selenium 23% Fiber 0%

There are some goodies in 1 egg including B12, selenium, magnesium and zinc. I won’t call it a superfood because I don’t believe in superfoods, but the components of life are there. After all those yolks are supposed to develop into chicks. The protein in an egg is some of the most easily digestible protein that man has. The cholesterol is wonderful, especially if you want to keep libido and strength.

Recently a “study” was published showing that eggs may be harmful to your health. (1) Basically they had people jot down in a journal how many eggs they had been eating on average per week and then factored that into how long they had been eating the eggs over the years. If you can remember how many eggs you’ve eaten on average per week for years at a time you must be a savant. Studies of this nature are usually rife with innaccuracies. It’s kind of like asking how many times you wore a particular shirt a month for the last few years. I could give you my estimate but I’m sure it would be off.

That part of the study really isn’t all that surprising to me since questionaires using memory recall have been done in the past. What really gets me is the following; the participants were arranged by “egg- yoke years” which means that as you aged you ate more eggs which put you into a different quintile or group. It is akin to pack-years that is used to quantify smokers in some studies. Well it’s no freaking shocker that as you age, if you eat eggs, that you will have eaten more eggs than someone 20 years younger than you. It is also known that as you age the risk of cardiovascular diseas increases. The author, Dr. Spence, concluded that increases in egg-yoke years increased the area of the plaques in the arteries after being adjusted for age. So in a person who is older and that already has heart disease is at more risk if they’ve been eating eggs, at least according to the author.

 Another problem is that all of these subjects were already sick with cardiovascular disease. Many were also overweight and had hypertension. This is also a cross-sectional study which means it really didn’t look at possible confounders (ie what other aspects of diet and activity were present) and you can make no cause-effect statements from any conclusions you might draw based on the data. So if you don’t control somehow for egg consumption there really is no way to know if eggs are the problem or not.  All it really does is leaving a person to ask more questions, or if you have already done some research, why would someone publish this? Let me explain.

This is taken from another study done by the main author, “None of the authors receives funding from purveyors of margarine or eggs. (no duh) Dr Spence and Dr Davignon have received honoraria and speaker’s fees from several pharmaceutical companies manufacturing lipid-lowering drugs (BINGO), and Dr Davignon has received support from Pfizer Canada for an annual atherosclerosis symposium (DING DING); his research has been funded in part by Pfizer Canada, AstraZeneca Canada Inc and Merck Frosst Canada Ltd” (The companies that make Lipitor, Crestor and Zocor respectively). So Dr. Spence is getting money from the pharmaceutical industry. It should now be no wonder why a study like this is being published.

In an older, and much larger study of nearly 118,000 men and women, there were no significant associations between egg intake and cardiovascular risk. (2) Dr. Spence argues that because people like the egg industry cite mentioned studies and don’t defer to the “leading experts” that people get confused on the matter of eggs. (3) It’s studies like these that make me wonder how many scientists out there really want to follow the scientific process and not be influenced by money or personal beliefs. If there were data (meaning multiple prospective randomized trials that were well done and repeatable) that showed eggs cause cardiovascular events, I would probably reevaluate my diet. But they don’t exist. Eggs are a great source of protein, fats and vitamins, including choline which may be very important in non-alcoholic fatty liver disease.

It is completely possible that Dr. Spence and others truly have the public interest at heart when doing these types of studies, but I can’t dismiss the possiblity that things like money might be involved especially when the author of a study is connected to the drug industry. I think eggs are great and still eat them and feel great. I wouldn’t down 8 whole eggs daily but I do eat them regularly and think unless a person has an allergy that they are a fine part of a diet that can be useful in obtaining vitamins.

CIAO

The Brute

1. Spence JD, Jenkins DJA, and Davignon J. Egg yolk consumption and carotid plaque. Atherosclerosis 2012; DOI:10.1016/j.atherosclerosis.2012.07.032. Available at: http://atherosclerosis-journal.com

2. Hu FB, Stampfer MJ, Rimm EB, et al. A Prospective Study of Egg Consumption and Risk of Cardiovascular Disease in Men and Women. JAMA. 1999;281(15):1387-1394

3. http://medicinemalaysia.com/wp2/?p=1777

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.