Should you take asprin to prevent heart attack

Well should you
Thiw will downlaod a pdf file

Statins again.

Talk given by Uffe Ravnskov in Sidney August 2006


Malcolm Kendrick. Short but interesting. WHO data

Aborigines have the highest rate of cardiovascular disease (CVD) - lowest cholesterol
Swiss have highest cholesterol and lowest CVD.

Evidence for Caution: Women and statin use A meticulous 36-pages report about the senseless and dangerous use of statins in women.

Are Statins Overused?, by Malcolm Kendrick

The above all come from here

Here is Ellison's E Book The hidden truth about cholesterol

According to Ellison, studies have consistently linked high cholesterol to lower mortality. For example:

Low cholesterol is associated with heart arrhythmia.

The European Heart Journal published a 3-year study of 11,500 patients finding those with low cholesterol to have a risk of all-cause death 2.27 times higher than those with high cholesterol.

The Journal of Cardiac Failure published an analysis of 1134 patients with heart disease and found low cholesterol to be associated with the worst outcomes in heart failure patients and impaired survival, while high cholesterol improved survival rates.

The American Geriatrics Society reported in 2003 that, in patients over the age of 65, even cholesterol levels up to 417 mg/dL were associated with lower mortality compared to levels under 189 mg/dL.

Should young people be given antidepressants?

(1) Should young people be given antidepressants?
(Head to Head: Should young people be given antidepressants?)
Yes: http://www.bmj.com/cgi/content/full/335/7623/750
No: http://www.bmj.com/cgi/content/full/335/7623/751
Not sure whether this is free or not

serotonin syndrome

The manifestations of the serotonin syndrome fall into three general areas:

1. Cognitive or behavioral changes such as confusion, agitation, lethargy, and coma.
2. A condition that is referred to as autonomic instability that includes elevated temperature, rapid heart rate, sweating, nausea, vomiting, diarrhea, and dilated pupils.
3. Neuromuscular changes that include spasm or twitching a muscle or group of muscles, exaggerated reflexes, and tremor.

Here's a list of drugs that have been associated with this according to article in bestpillsworstpills

Concerned re side effect

It's only 15 US per annum.
The cut and paste below comes from here - it's free
Here is some more free stuff on drugs

• Each year, in hospitals alone, there are 28,000 cases of life-threatening heart toxicity from adverse reactions to digoxin (DIGITEK, LANOXICAPS, LANOXIN), the most commonly used form of digitalis (drugs that regulate the speed and strength of heart beats) in older adults.
• Each year 41,000 older adults are hospitalized — and 3,300 of these die from ulcers caused by NSAIDs (nonsteroidal anti-inflammatory drugs, usually for treatment of arthritis). Thousands of younger adults are hospitalized.
• At least 16,000 injuries from auto crashes each year involving older drivers are attributable to the use of psychoactive drugs, specifically benzodiazepines and tricyclic antidepressants. Psychoactive drugs are those that affect the mind or behavior.
• Each year 32,000 older adults suffer from hip fractures attributable to drug-induced falls, resulting in more than 1,500 deaths. In one study, the main categories of drugs responsible for the falls leading to hip fractures were sleeping pills and minor tranquilizers (30 percent), antipsychotic drugs (52 percent), and antidepressants (17 percent). All of these categories of drugs are often prescribed unnecessarily, especially in older adults.
• Approximately 163,000 older Americans suffer from serious mental impairment (memory loss, dementia) either caused or worsened by drugs. In a study in the state of Washington, in 46 percent of the patients with drug-induced mental impairment, the problem was caused by minor tranquilizers or sleeping pills; in 14 percent, by high blood pressure drugs; and in 11 percent, by antipsychotic drugs.
• Two million older Americans are addicted or at risk of addiction to minor tranquilizers or sleeping pills because they have used them daily for at least one year, even though there is no acceptable evidence that the tranquilizers are effective for more than four months, and the sleeping pills for more than 30 days.
• Drug-induced tardive dyskinesia has developed in 73,000 older adults; this condition is the most serious and common adverse reaction to antipsychotic drugs, and it is often irreversible. Tardive dyskinesia is characterized by involuntary movements of the face, arms and legs. About 80 percent of older adults receiving antipsychotic drugs do not have schizophrenia or other conditions that justify the use of such powerful drugs, so many of these patients have serious side effects from drugs that were prescribed inappropriately.
• Drug-induced parkinsonism has developed in 61,000 older adults also due to the use of antipsychotic drugs such as haloperidol (HALDOL), chlorpromazine (THORAZINE), trifluoperazine (STELAZINE), fluphenazine (PROLIXIN), and thioridazine (MELLARIL). There are other parkinsonism-inducing drugs as well, such as metoclopramide (REGLAN), prochlorperazine (COMPAZINE), and promethazine (PHENERGAN), prescribed for gastrointestinal problems.

xenical

The Diet Drug Orlistat (XENICAL) and Gallstones
(June 2007)
Yet another problem has been detected with this diet drug whose approval we opposed and that we have been attempting to get banned. The FDA found 37 cases of gall stones in patients using orlistat. This, in addition to inhibiting the absorption of important vitamins such as A, D, E and K as well as evidence that the drug can cause pre-cancerous abnormalities in the colon of animals, further emphasizes why this barely effective drug should not be used, either in the prescription version called Xenical or the about-to-appear over-the-counter version, Alli.

Low-Dose Aspirin for Heart Protection: How Low Should a Safe Dose Be?

Daily aspirin protects the heart, but the dose at which this can be safely accomplished has never been established. It has long been known that the risks of aspirin—gastrointestinal or brain hemorrhage—cannot be completely eliminated even at the lowest possible doses. An international team of researchers recently determined that daily doses of aspirin as low as 30 mg are adequate for achieving the anti-clotting goal; whereas doses higher than 75 to 81 mg merely increase the risk of adverse reactions without providing any additional advantage.

Avandia Debacle

Scarcely two weeks after the Senate overwhelmingly passed legislation touted as a major fix of FDA’s failing effort to assure drug safety, The New England Journal of Medicine published an analysis linking the diabetes drug Avandia to a 40% increase in the risk of heart attack. This finding is especially troubling because people with diabetes are already at high risk of cardiovascular problems. A million diabetics are estimated to be current Avandia users in the U.S.

Se here for rest of article

BP oh dear

Their findings were that 'Shockingly, we have found that the Framingham data in no way supported the current paradigm to which they gave birth. In fact, these data actaully statistically reject the linear model.'

Treating hypertension with guidelines in general practice

ARE ANTIDEPRESSANTS AS EFFECTIVE AS CLAIMED?

NO, THEY ARE NOT EFFECTIVE AT ALL

Click here to hear the Reviewer's comments via MP3.

Moncrieff, J., et al, Can J Psych 52(2):96, February 2007

This British author challenges the tenet that antidepressant drugs specifically act on abnormal cerebral states to relieve depression. She points out that meta-analyses of the myriad of published randomized, controlled trials comparing antidepressants and placebo generally show only a small advantage of active treatment, further noting that trials with negative results are much less likely to be published. The author suggests that reported effects of antidepressant drugs might be due to nonspecific sedative effects of these agents on outcomes such as sleeping difficulties and anxiety rather than to a truly antidepressant effect. She cites the findings of naturalistic studies that have reported that patients treated with antidepressants do less well than those who are not so treated. The prevalence of depressive episodes, suicide and sickness absence due to depression has been progressively increasing in western countries, despite a profound increase in antidepressant prescribing, suggesting that the use of antidepressants has done little to reduce the consequences of depression. Addressing studies reporting relapse of depression after discontinuation of long-term antidepressant therapy, this author feels that this phenomenon does not necessarily provide evidence of the effectiveness of antidepressants but rather might reflect the occurrence of discontinuation symptoms that are mistakenly diagnosed as early signs of relapse. In support of this premise, she cites the findings of one meta-analysis of maintenance antidepressant studies reporting that relapses tended to cluster after withdrawal of treatment, with the risk declining thereafter. The author concludes that there is no reason to suppose that the diverse problems that are labeled as "depression" can be reversed by antidepressant drugs. 9 references (j.moncrieff@ucl.ac.uk)

Nicotine patches in ICU

Giving very sick patients nicotine replacement therapy may not be entirely safe, although it is sometimes given to smokers in the intensive care unit (ICU) to prevent withdrawal. A retrospective case-control analysis of this treatment in ICU patients found that it is associated with increased in-hospital mortality—20% in smokers who took the treatment versus 7% in those who did not. Treatment remained independently associated with increased mortality when severity of illness and invasive mechanical ventilation were adjusted for (Critical Care Medicine 2007;35:1517-21 doi: 10.1097/01.CCM.0000266537.86437.38).

Betablockers post MI - NICE guidelines

• early after an acute MI, all patients without left ventricular systolic dysfunction or with left ventricular systolic dysfunction (symptomatic or asymptomatic) should be offered treatment with a beta-blocker
• for patients after an MI with left ventricular systolic dysfunction, who are being offered treatment with a beta-blocker, clinicians may prefer to consider treatment with a beta-blocker licensed for use in heart failure
• beta-blockers should be continued indefinitely after an acute MI
• after a proven MI in the past, all patients with left ventricular systolic dysfunction should be offered treatment with a beta-blocker whether or not they have symptoms, and those with heart failure plus left ventricular systolic dysfunction should be managed in line with 'Chronic heart failure' guidance
• after a proven MI in the past, patients with preserved left ventricular function who are asymptomatic should not be routinely offered treatment with a beta-blocker, unless they are identified to be at increased risk of further cardiovascular events, or there are other compelling indications for beta-blocker treatment
• beta-blockers should be initiated as soon as possible when the patient is clinically stable and titrated upwards to the maximum tolerated dose.

Diabetes and actos like drugs

Rosiglitazone and Cardiotoxicity — Weighing the Evidence

David M. Nathan, M.D.
Worstpills bestpills has a do not use notice on these drugs. Subscription to their website is minimal. They look for what's wrong rather than what's right and good on them!! They have some recent stuf on actos and sibling meds.

Cervical cancer vaccine

Judicial Watch Uncovers Three Deaths Relating to HPV Vaccine

Click here to view the Garadsil Related Deaths Reported to VAERS as of May 11, 2007

Click here to view the Vaccine Adverse Event Reporting System (VAERS) Reports as of May 11, 2007

Fainting schoolgirls wipe $A1bn off market value of Gardasil producer

Hysteria or what!

NNT - how come some are so different

There's another instructive way to consider the numbers. Suppose that 100 people with high cholesterol levels took statins. Of them, 93 wouldn't have had heart attacks anyway. Five people have heart attacks despite taking Pravachol. Only the remaining two out of the original 100 avoided a heart attack by taking the daily pills. In the end, 100 people needed to be treated to avoid two heart attacks during the study period—so, the number of people who must get the treatment for a single person to benefit is 50. This is known as the "number needed to treat - see rest of
article

Example

Sixty-year-old female with hypercholesterolaemia

The readily available New Zealand cardiovascular risk calculator can quantify absolute risk. With a blood pressure of 130/80, total cholesterol of 7.5 mmol/L, and an HDL cholesterol of 1.1 mmol/L, a non-smoking non-diabetic female has a fiveyear cardiovascular event risk of 7%. It is generally agreed that statins will reduce risk by a third. With treatment the five-year risk is thus about 5%.

When discussing the merit of treatment against the effort and potential adverse effects, consider the absolute risk reduction. About seven in 100 people will have an event in five years with no treatment, but if 100 take the statin for five years, five will have an event.

Beta blockers 20 people for five years
Asprin like drugs 50 people for five years
Statins 100 people for five years
take a look

Here's more on statins

Here's a good one with statins relating NNT to cardiovascular risk
same here NZ calculator

BP treatment 50 to 80 need to be treated for five years to prevent one death. And about 20 for five years to prevent one cardiovascular event.

Here's another list of NNTs
And another list of NNTs

Here Bandolier on NNT and here

some more statin ones in primary prevention and .

• the authors affirm that statin therapy could reduce the absolute risk of coronary events during the next 4.3 years by 0.75% in low-risk patients (NNT= 133), by 1.63% (NNT=61) in moderate-risk patients and by 2.51% (NNT=40) in high-risk patients. They also conclude that it could be cost-effective in patients with an absolute risk over 20% of having a coronary event in the following 10 years. It would not be cost-effective in patients with a risk <10%,>
• the study authors concluded that, in patients without CV disease, statin therapy decreases the incidence of major coronary and cerebrovascular events and revascularizations but not coronary heart disease or overall mortality

Reference:

1. Thavendiranathan P et al. Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006 Nov 27;166(21):2307-13.

CVD interventions in the elderly

Over 3.5 years and little benefit

Dem bones

The use of an SSRI among persons aged 50 and older appears to be associated with an approximately two-fold increase in the risk of fragility fractures Richards, J.B., et al, Arch Intern Med 167:188, January 22, 2007

An increased risk of hip fractures with long-term use of PPIs among patients over the age of 50. Yang, Y.X., et al, JAMA 296(24):2947, December 27, 2006

Renal failure and medication

An over view - check it out.

glitazones - diabetes

Drug Avandia

Statement by Sidney Wolfe, MD, Director of Health Research Group at Public Citizen

The New England Journal of Medicine study just released showing a 43 percent increase in heart attacks in people using Avandia should come as no surprise either to the Food and Drug Administration (FDA) or to Glaxo. In animal studies done prior to its approval, one of the most constant findings was damage to the heart, and within the first six years of approval there have been 689 cases of heart failure reported to the FDA in patients using the drug. In addition, there have been reports of anemia which, along with heart failure, increases the risk for a heart attack.

other side effects

• principal unwanted effects include weight gain (about 5%, or 3.5 kg over 6 months)
• water retention and leg oedema (in about 5%)
• dizziness, headache, fatigue, and hypoglycaemia (only when used in combination with a sulphonylurea) has also been reported with both drugs in combination therapy
• other reported effects with pioglitazone include visual disturbances, arthralgia, impotence, flatulence, proteinuria, haematuria and with rosiglitazone, gastrointestinal disturbances, rash, paraesthesia, dyspnoea, rash, alopecia and thrombocytopaenia
• since rosiglitazone and pioglitazone can cause fluid retention, which may exacerbate or precipitate heart failure, these drugs should be avoided in patients with any current, or history of heart failure - note that all patients taking either glitazone should be monitored for features of heart failure
• macular oedema - cases of new onset and worsening macular oedema have been reported in patients treated with rosiglitazone. It has been reported that "in some cases, macular oedema resolved or improved following discontinuation of therapy and in one case macular odema resolved after dose reduction "(2)
• cardiovascular risk - there has been evidence from a meta-analysis concerning the use of rosiglitazone and increased risk of myocardial infarction (3) - for more detail see linked item

Here is some debate about the heart attack issue

My thoughts - it's not that effective so why bother with it at all!!!

ACE Diuretic, NSAIDS and renail failure

Beware the triple whammy!

ADRAC has previously warned prescribers about the 'triple whammy' - the combination of an ACE inhibitor (ACEI) or an angiotensin II receptor antagonist (A2RA), a diuretic and an NSAID (including a COX-2 selective NSAID), which may predispose vulnerable patients to renal failure.^1,2,3 Risk factors include advanced age, pre-existing renal impairment and dehydration. In 2005, ADRAC received 21 reports of renal failure in patients who were exposed to the triple whammy. In a number of cases, precipitating factors included an acute illness, dehydration, digoxin toxicity or the recent addition of an NSAID to a patient already on an ACEI or an A2RA and a diuretic.