Wednesday, October 6, 2010

As of this year Merck has settled the majority of Vioxx claims following their 2004 "voluntary" removal of the heart-attack-causing medication. It has cost them 4.85 billion dollars. They ghostwrote the "scientific" studies for false marketing purposes and hid safety data from the FDA. The FDA allowed the drug on the market over the objection of its safety scientists. Finally, the likely mechanism explaining why Vioxx caused cardiovascular death has apparently been stumbled onto. The mechanism of injury raises serious risks for any NSAID drug as well as other drugs of safety concern, such as fibrates, that are used to lower cholesterol and triglycerides.

NSAIDs (nonsteriodal anti-inflammatory drugs) are supposed to reduce pain by blocking production of an enzyme called COX-2 (Cyclooxygenase 2). Two of the specific COX-2 inhibiting pain killers have been removed from the market (Vioxx and Bextra), while Celebrex is still on the market. There are a number of other NSAIDs that block COX-2 and COX-1, including aspirin, Indocin, Advil, Motrin, Naprosyn, Feldene, and Relafin. Any of these drugs, especially in high doses, are relevant to the side effect I am about to explain.

Also, fibrates (Lopid and TriCor), which are commonly used in conjunction with statins to lower cholesterol and triglycerides, are implicated by the findings of this study. These drugs are also associated with heavy increased adverse risks when combined with statins (as is their common use).

The problem for Western medicine is what they label as "bad" and then target with a drug is often doing something good as well. When the good aspect is missing from metabolism then problems can happen.

The COX-2 enzyme generates pro-inflammatory fatty-acid signal called protaglandins. Blocking these signals can reduce pain. However, the new study shows that COX-2 activity is also required to clear another type of fatty acid metabolite called 20-HETE (20-hydroxyeicosatetraenoic acid). 20-HETE is normally made in the circulatory system and kidneys. It is part of the natural ebb and flow of the pulse of blood pressure. It has a vascoconstrictive effect. In excess levels 20-HETE generates significant free radical damage and causes platelets to stick together, thus inducing a heart attack. The COX-2 enzyme plays a role in helping to reduce and balance 20-HETE levels, making its presence needed for normal function of circulation.

Your kidneys are also a primary site of 20-HETE production. Excess production can be caused by too much salt intake as well as other drugs like fibrates.

The primary mechanism for lowering 20-HETE is by the production of the vasorelaxant known as friendly nitric oxide (eNOS). Most people in pain have way too much unfriendly/inflammatory nitric oxide (iNOS) and already lack eNOS.

This data means that a person who took Vioxx while also eating excess salt, especially in combination with a blood pressure problem or while also taking a fibrate was a walking time bomb.

This data also means that if you need to take a NSAID for any period of time you should minimize salt intake during that time and take nutrients that help promote eNOS production and lower iNOS production, while supporting kidney balance. Top choices would be grape seed extract, resveratrol, potassium, and magnesium. In general, antioxidants and natural polyphenols of any type should be maximized, which will help pain anyway.

It is quite possible on any high dose of NSAIDs to produce excess levels of 20-HETE, thus placing oneself at risk for a heart attack. Taking prudent steps to avoid these drugs, using the lowest amounts possible for the shortest amount of time, and using nutrients to help offset their side effects is common sense.