Wednesday, February 28, 2007

Popular painkillers claimed to increase risk of heart disease

This is another chicken and egg finding where the authors boldly but incautiously say the chicken came first. It seems more reasonable to conclude that people with health problems -- including high blood pressure -- are more likely to take painkillers. But I guess that is too unsurprising to get an article devoted to it into a medical journal

Popular painkillers such as aspirin, ibuprofen and acetaminophen can raise blood pressure and thus the risk of heart disease among men, US researchers report. Men who took such drugs for most days in a week were about a third more likely to be diagnosed with high blood pressure than men not taking them, the researchers found. Their findings, published in the Archives of Internal Medicine, reinforce a study published in 2002 that these commonly used drugs raise blood pressure in women. "This is a potentially preventable cause of high blood pressure," Dr John Forman of Brigham and Women's Hospital in Boston, who led the study, said.

Millions of people take the painkillers as pills every day to treat headaches, arthritis, muscle pulls and other aches and pains. "These are the three most commonly used drugs in the United States," Dr Gary Curhan, who also worked on the study, said in an interview.

For their study, the researchers looked at a continuing study of male health professionals. After they filtered out everyone who already had high blood pressure and other problems, they had 16,000 men whose records they checked for four years. Men who took acetaminophen (paracetamol), sold generically and under the Tylenol brand name, six or seven days a week were 34 per cent more likely to be diagnosed with high blood pressure than men who did not take analgesics.

Men who took aspirin that regularly were 26 per cent more likely to have high blood pressure than non-users. For non-steroidal anti-inflammatory drugs, or NSAIDS, which include ibuprofen and naproxen, the increased risk was 38 per cent. Men who took 15 or more NSAID pills a week were 48 per cent more likely than non-users to have high blood pressure. The drugs can affect the ability of blood vessels to expand, and may also cause sodium retention - two factors that can both raise blood pressure. Being overweight reduced the risk from acetaminophen, but raised the risk from NSAIDS, the researchers found.

But men who were advised by a doctor to take an aspirin a day to reduce the risk of heart attack and stroke should not stop taking them, cautioned Dr Curhan. "The benefit outweighs the risk," he said in an interview. The American Heart Association issued its own advisory based in part on the report's findings. "We advise physicians to start with non-pharmacologic treatments such as physical therapy and exercise, weight loss to reduce stress on joints, and heat or cold therapy," said the Association's Dr Elliott Antman, also of Brigham and Women's Hospital.

The Heart Association was especially worried about the use of COX-2 inhibitors, prescription arthritis drugs designed to be safer than NSAIDS. Many have been found to actually raise heart risk and cause strokes. "We believe that some physicians have been prescribing the new COX-2 inhibitors as the first line of treatment. We are turning that around and saying that, for chronic pain in patients with known heart disease or who are at risk for heart disease, these drugs should be the last line of treatment," Dr Antman said.

Dr Curhan said it would be important to study patients directly, not simply look at their medical records, to fully understand the risks and what might be causing the effect. "Even if we can't explain the direct mechanism, it seems pretty clear," he said.


Garlic 'doesn't work' for cholesterol: Researcher claims

But the study is based on very limited sampling -- non-sampling, actually -- and a relatively short time period. On balance, however, the conclusion is probably right -- at least as far as the narrow range of health effects examined is concerned. The journal abstract is here

Eating garlic raw or in supplement form does not lower "bad" cholesterol levels, despite widespread health claims for the pungent plant bulb, researchers said today. "It just doesn't work," said Christopher Gardner of the Stanford Prevention Research Centre in California. "There's no shortcut. You achieve good health through eating healthy food. There isn't a pill or an herb you can take to counteract an unhealthy diet."

Some of the claims that garlic lowers cholesterol emanate from laboratory experiments but there is no proof it reacts in the body the same way, Gardner wrote in the Archives of Internal Medicine. In test tubes and some animal subjects the compound released from crushed garlic, allicin, has been found to inhibit the synthesis of cholesterol. But in Gardner's study of 192 subjects who had slightly elevated levels of low-density lipoprotein (LDL), the so-called bad cholesterol that tends to clog arteries, garlic had no impact. "Our study had the statistical power to see any small differences that would have shown up, and we had the duration to see whether it might take a while for the effect of the garlic to creep in. We even looked separately at the participants with the highest versus the lowest LDL cholesterol levels at the start of the study, and the results were identical," Gardner said.

The participants' cholesterol levels ranged from 130 milligrams per deciliter of blood to 190 milligrams - any higher and their doctors would have prescribed cholesterol-lowering statin drugs, he said. The study's funding came from the US National Institutes of Health. The participants were divided into four groups: one ate a clove of garlic six days a week, usually in a gourmet sandwich prepared for them; two other groups consumed the equivalent amount of garlic either in a popular garlic supplement pill or powder, one of which advertised itself as "aged" garlic that removed the bad-breath problem; and the other group consumed a placebo. Gardner said other health claims ascribed to garlic - that it strengthens the body's immune system and combats inflammation and cancer - needed to be studied, too.

Garlic's healthy reputation goes back to the ancient Egyptians, and it was widely consumed by the Greeks and Romans. Its juice has also been used as an antiseptic. Its assumed benefits may have something to do with it growing wild around the Mediterranean, where diets are often rich in healthy olive oil, fish, nuts and fruit. Garlic can be helpful in spicing up healthy dishes, such as stir fry or Mediterranean salads, Gardner said. "But if you choose garlic fries as a cholesterol-lowering food, then you blew it," he said.



Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

Trans fats:

For one summary of the weak science behind the "trans-fat" hysteria, see here. Trans fats have only a temporary effect on blood chemistry and the evidence of lasting harm from them is dubious. By taking extreme groups in trans fats intake, some weak association with coronary heart disease has at times been shown in some sub-populations but extreme group studies are inherently at risk of confounding with other factors and are intrinsically of little interest to the average person.