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M. P. Ravindra Nathan
By M. P. Ravindra Nathan, MD, FACC

If you are still confused over the recent publicity about the cardiovascular risks of some arthritis pain medicines, you are not alone. I had to field several questions from my nervous patients too like:

“Oh, I have taken these so long, am I likely to get a heart attack?”

“Which ones are safe to take now?”

“When would they resolve these issues?”

In September 2004, a drug called Vioxx (Refecoxib), manufactured by Merck & Co was pulled from the market suddenly because of the concerns that it may increase the risk of stroke and heart attacks. This came as a shock to the patients, longtime sufferers from arthritis, who immensely benefited from this drug. It was relatively easy on the stomach in comparison to other similar drugs, broadly classified as NSAIDs (non steroidal anti-inflammatory drugs) such as Ibuprofen. Doctors were surprised too, as one mentioned, “Finally we had a dependable drug which the patients liked and it really worked. Now you are taking that away.”

The series of reports that quickly unfolded after the initial withdrawal of the drug had been quite alarming. Both patients and doctors started worrying whether this is a class effect and hence is it wise to use other COX-2 inhibitors such as Celebrex and Bextra? The media tried to analyze the pros and cons of such an event-making decision by Merck, writing editorials and throwing the blame around. Vioxx brought in huge profits for Merck and the stockbrokers even hinted at the possible demise of this blue chip company.

Emotions aside, Vioxx, the brand name for a commonly prescribed drug for arthritis, muscular pains in adults and painful menstrual cycles, was pulled off the market after a clinical trial showed it might cause an increased risk of heart attack and stroke if used long term. Because of the trial's findings, Merck voluntarily withdrew Vioxx from the market worldwide. Pfizer immediately released a statement reminding the medical community that Celebrex (its competitor) was considered safe. Three months later, the company halted a cancer prevention trial after it was shown that patients assigned the 800 mg dose of Celebrex also had a 3.4 fold greater risk of cardiovascular events.

Trial lawyers quickly jumped into the fray. There are a lot of arthritis sufferers in America as the population is aging and they all become scared when they hear words like “heart attacks and strokes.” So trial lawyers went to work quickly and commercials and ads like “Did you take Vioxx for arthritis? If so, contact this firm urgently” started popping up. They argued such a drug could have injured a lot of people.

Now, there are concerns about other NSAIDs like Naproxen (Aleve) as well. A trial that was designed to assess the potential benefit of long-term use of Naproxen and Celebrex for decreasing the risk of Alzheimer’s disease was recently halted because of some concerns. It is ironic that ‘inflammation’ is now considered a major culprit in the genesis of coronary artery disease and yet these anti-inflammatory drugs may be harmful to the heart!

What is the upshot of all of these to the consumer? All drugs in the NSAIDs class are under a cloud of suspicion now. Although COX-2 inhibitors may differ in their cardiovascular effects and some may be safer than others, it is better to avoid these drugs especially if you are at high risk for or suffer from heart disease and strokes. So, it is better to wait for the soon-to-be-released recommendations from FDA’s Arthritis Advisory Committee. No drug is safe from side effects and that is the nature of all pharmaceutical agents. So, use them only under the direction of your physician and for indications, which are appropriate.

Cardiologist Dr. M. P. Ravindra Nathan lives in Brooksville.

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