Re: Increased risk of heart disease?

[Guest guest]

The Mayo clinic did a study and it concluded that there is a correlation between heart disease and RA here is the link to an article about it

http://arthritis.about.com/od/rheumatoidarthritis/a/mayoheartstudy.htm

Betty

[Guest guest]

Thanks, Toni, I would be interested in reading the information.

> >

> > I understand that along with the diagnosis of RA goes an increased

> > risk of developing heart disease. Does anyone have more information

> > on this? Have there been studies done to confirm this and are there

> > any measures that can be taken to reduce the risks?

> >

> > I would appreciate your comments.

> >

> > Thanks

> >

> >

>

[Guest guest]

Definitive study of anti-inflammatories in heart disease?

Dec 14, 2005

Zosia Chustecka

Cleveland, OH - A huge trial comparing three anti-inflammatories in patients with both heart disease and arthritis should answer once and for all questions about the relative cardiovascular risks of these agents, says lead investigator Dr Nissen (Cleveland Clinic, OH). " There's no question that this will be the definitive trial, " he tells rheumawire. " It's large enough with 20 000 patients, and it's looking at the right drugs in the right patient population. " In fact, he points out, no previous study has looked specifically at patients with heart disease, so " this is new territory. "

The trial will compare the COX-2-selective agent celecoxib (Celebrex, Pfizer) with two traditional nonsteroidal anti-inflammatory drugs (NSAIDs), naproxen and ibuprofen. Until now, celecoxib has been considered to be less risky for the GI tract, and naproxen less risky for the cardiovascular system, with ibuprofen falling somewhere in between, Nissen says. " Now we will see how they compare in a real-life situation. " All the trial participants will have both arthritis and heart disease (eg, prior myocardial infarction or stroke, angioplasty, peripheral vascular disease, and/or diabetes), so they are high-risk secondary-prevention patients. As a result, all of them will be taking low-dose aspirin for cardiovascular prophylaxis; in addition, all of the patients will also be taking a proton pump inhibitor (omeprazole) to protect the gastrointestinal tract and to ensure blinding across the three arms, Nissen explained. " This pitches the three drugs on a level playing field, " he said. " Let the chips fall where they will. "

The trial addresses an urgent clinical question. " At the moment, we just don't know what to advise patients, " he says. " Almost every day I have patients coming into the clinic with heart disease and arthritis, and they are asking me what they should they take for pain relief. We haven't had a way to answer that question.

" I think that we will be able to sort out the cardiovascular safety, the gastrointestinal safety, and also the pain relief, " Nissen tells rheumawire in an interview. " And we'll have what I believe will be a really strong and powerful statistical analysis. " Results will be available about four years from now, he says, but if there is a clear difference between the drugs, it may emerge earlier. The first patient will start in the new year, and enrollment is expected to take about 18 months, with follow-up planned for two years.

Firewall between trial and industry funding

Known as the Prospective Randomized Evaluation of Celecoxib Integrated Safety versus Ibuprofen or Naproxen (PRECISION), the trial will be funded by Pfizer and has been estimated to cost in the region of $100 million. However, there will be a firewall between the company and the trial, Nissen says: the Cleveland Clinic will run the trial independently of the company, and all of the data will be housed at the clinic. He says, " We intend to share a copy of the data with the US

National Heart, Lung, and Blood Institute. "

Pfizer has been talking for some time now about carrying out a trial to establish the cardiovascular safety of celecoxib, but plans for a trial dubbed 4C, which had aimed to show benefits in heart-disease patients, were abandoned after data showing a CV risk with the drug emerged and a black-box warning was added in the US. Nissen says that Pfizer approached him about the current study in August, but it has taken months to plan, and he notes that the executive committee sought input from both the US FDA and the European agency EMEA on the design of the trial. " It's really a consensus from academia, industry, and government on what needs to be done, " Nissen says, " and I can assure everyone that we are committed to doing this with the best scientific methods and a high degree of independence. "

None of the investigators on the executive committee responsible for the trial are allowed to have any financial relationship with any manufacturer of analgesics or anti-inflammatories, either marketed or still in development, or with any hedge funds, financial institutions, or lawyers involved in Vioxx trials. " I absolutely insisted on that point, " Nissen tells rheumawire, emphasizing that there must be total transparency and distancing of the science from industry, especially in the current climate. " The withdrawal of Vioxx and the black-box warnings have seriously shaken public confidence in the safety of commonly used painkillers, " he says. " We understand that to restore public confidence, there has to be complete transparency. " annette

[Guest guest]

This and the one above are from the Joint & Bone newsletter

AnnetteRA patients don't use routine low-dose aspirin, despite high CV risk

December 1, 2005

Janis

San Diego, CA - Rheumatoid arthritis (RA) patients are less likely to take daily preventive doses of aspirin to reduce cardiovascular (CV) risks, despite the increased risk of heart attack associated with RA, according to survey data presented at the 2005 ACR/ARHP Annual Scientific Meeting [1].

" Rheumatologists might be assuming that aspirin prescriptions will be dealt with by the primary-care physician who will initiate the prophylactic regimen. We need better communication between rheumatologists and primary-care physicians so that cardiovascular protection for RA patients does not fall through the cracks, " said lead author Dr Colglazier (now in private practice in Crestview Hills, KY).

RA patients one third less likely to use aspirin

We need better communication between rheumatologists and primary-care physicians so that cardiovascular protection for RA patients does not fall through the cracks.

The US Preventive Services Task Force recommends routine low-dose aspirin (81 mg-325 mg/day) for adults who are at increased risk of having a heart attack over the next 10 years. RA is associated with such a CV risk. Colglazier et al surveyed 14 114 RA patients semiannually for three years as part of an arthritis-outcomes study. Results in those patients were compared with outcomes in 4009 patients with noninflammatory rheumatic disorders.

Colglazier found that, adjusted for age and sex, RA patients had an expected greater risk of myocardial infarction (MI) compared with noninflammatory disorders (odds ratio [OR] 1.7.)

This probably reflects in part the fact that RA patients were much less likely to take low-dose aspirin (OR 0.67), and this did not change when history of MI was added as a covariate.

The age- and sex-adjusted rates of low-dose aspirin use were 18.4% for RA patients and 25.1% for patients with noninflammatory rheumatic diseases.

Rheumatologists should be aware that RA patients . . . receive less than the recommended care for prophylaxis and treatment of CV disorders

..

Among RA patients, men were more likely to use low-dose aspirin (OR 1.6). COX-2-inhibitor use was associated with greater use of low-dose aspirin (OR 1.06), as was white ethnicity (OR 1.20). Patients who used nonspecific NSAIDs were less likely to use low-dose aspirin (OR 0.89), as were patients with poorer functional status, increased pain, or use of prednisone.

" Although the rate of MI is increased in RA, use of low-dose aspirin by RA patients is reduced compared with non-RA patients. We were unable to find any clinical, demographic, or treatment variables that explained this rate difference. Several possibilities are suggested. Physicians may feel that the complicated RA treatments weigh against additional therapies. In addition, package inserts and pharmacists recommend against using aspirin with methotrexate or NSAIDs. Finally, rheumatologists, as subspecialists, may not address primary-prevention issues. Although further studies are needed to understand this discrepancy, rheumatologists should be aware that RA patients, on average, receive less than the recommended care for prophylaxis and treatment of CV disorders, " Colglazier said.

Source

Colglazier L, Wolfe F, Michaud K, et al. Rheumatoid arthritis (RA) patients are less likely to be treated with prophylactic aspirin despite an increased risk of myocardial infarction. 2005 ACR/ARHP Annual Scientific Meeting; Nov. 12-17, 2005; San Diego, CA. Abstract 1904.

[Guest guest]

Asthma drug raises heart risk

Glucocorticoids are used to treat asthma

Patients taking anti-inflammatory steroid drugs for conditions such

as asthma are at a greater risk of heart disease, research suggests.

Glucocorticoids are commonly prescribed to alleviate conditions

including asthma, rheumatoid arthritis and inflammatory bowel

disease.

Scientists from the University of Dundee have found that use of the

drugs may increase the risk of developing cardiovascular disease by

up to 70%.

The study focused on over 164,000 people from the Tayside area of

Scotland.

Nearly half had received at least one glucocorticoid prescription

between 1993 and 1996.

The higher the dose of the drug taken, the higher the risk of heart

disease appeared to be.

A decade of glucocorticoid use at the highest doses, taken by about

2% of the group, increased the risk of heart disease in over-40s from

approx 19 people in every 100 to 32 in 100.

Caution

Researcher Professor urged people not to worry.

He said: " These drugs are very effective in the treatment of certain

conditions.

" The overall benefits of treatment with glucocorticoids outweighs the

risks for most patients.

" However, this study reminds doctors to be cautious when using high

doses for extended periods, especially in patients already considered

to be at a greater risk of cardiovascular disease. "

Glucocorticoids, also called corticosteroids, are a group of anti-

inflammatory drugs that are related to cortisol, a natural steroid

hormone produced by the body.

They can produce serious side effects including a thinning of the

bones, susceptibility to bruising, infections, diabetes, cataracts,

glaucoma, high blood pressure and weight gain.

Professor Martyn Partridge, Chief Medical Advisor of the National

Asthma Campaign, also warned against drawing firm conclusions from

the study.

He said: " The study reported has only been presented in part at a

scientific meeting and the full report has not yet been published.

" It is important to note that any perceived risk for those with

asthma is with steroid tablets, and at high doses and over a long

period, whereas of course most people with asthma are on low doses of

inhaled steroids and use steroid tablets only occasionally for very

short periods.

" It is also important to realise that such population studies do need

to be interpreted with great care. "

He said previous studies suggesting people with asthma were at

greater risk of heart disease had been skewed by mis-classifying

people with smoking-related conditions as asthmatic.

Chicken and egg

Professor Sir , medical director at the British Heart

Foundation, said: " It should be remembered that high dose steroids

are very effective at controlling inflammatory processes, some of

which themselves carry an increased risk of coronary heart disease

e.g. rheumatoid arthritis.

" The study does not make it clear whether it's a " chicken or egg "

situation - is it the underlying condition that is causing an

increased risk of heart disease, or the medication?

" We fully agree that patients should not be scared off taking their

medication and should contact their GPs if they have any concerns. "

A spokeswoman for the Arthritis Research Campaign told BBC News

Online patients were always prescribed the lowest dose of steroids to

treat their condition.

" Unfortunately rheumatoid arthritis can be associated with cardio

vascular events, so it might be difficult to know whether it was

steroids or the disease itself which caused any heart probems. "

The research was presented at a meeting of the British Endocrine

Societies in Glasgow.

http://news.bbc.co.uk/1/hi/health/2881781.stm

[Guest guest]

Thanks for that article, Betty. It reminds me that I need to get my heart

checked more frequently. About 2 years ago I had a high CRP which is a test

for inflammation in the body, but some take it for inflammation around the

heart so I did have it checked out, but I should keep up on it, every couple of

years I guess.

>

> The Mayo clinic did a study and it concluded that there is a correlation

> between heart disease and RA here is the link to an article about it

>

> _http://arthritis.about.com/od/rheumatoidarthritis/a/mayoheartstudy.htm_

> (http://arthritis.about.com/od/rheumatoidarthritis/a/mayoheartstudy.htm)

>

> Betty

>