Diclofenac Causes as Many Heart Attacks as Vioxx
February 27, 2013
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By Dr. Mercola
A brand new meta-analysis reveals that the world’s most popular painkiller is as dangerous as ill-fated Vioxx. Vioxx (refecoxib) was pulled from the American market in 2004 — but not until 60,000 people had lost their lives from heart attacks and strokes as a deadly side effect of the drug.
Diclofenac is in the same category as Vioxx, representing nonsteroidal anti-inflammatory drugs (NSAIDS) classified as COX-2 inhibitors.
Diclofenac is one of the oldest NSAIDs, with prescriptions dating back to the 1970s for all types of inflammatory problems, including arthritis, back pain, gout, headaches and fever.
Although not terribly popular in the U.S., diclofenac is the most widely prescribed NSAID worldwide, sold under the brand names Voltaren, Cambia, Cataflam and Zipsor. Diclofenac far outsells ibuprofen, naproxen, and other NSAIDs in 15 countries around the world1.
In Canada, it is the third most prescribed NSAID. And in England, six million people were prescribed diclofenac last year. Of particular concern is the overuse of this drug in low- and middle-income countries where cardiovascular disease rates are on the rise.
Diclofenac Can Raise Your Risk of Heart Attack or Stroke by 40 Percent
All NSAIDs are associated with significant side effects, including increased risk for heart attack and stroke. But how do they do this? The reason is that, along with inhibiting the “bad” prostaglandins that cause inflammation and pain, they inhibit the “good” prostaglandins that dilate your blood vessels and increase blood flow.
So when those “good” prostaglandins are suppressed, the result is higher blood pressure and increased blood clotting. It was initially believed that your body’s own nitric oxide would compensate for these effects, but recent studies have shown this is not the case.
The cardiovascular risk is greatest for people who already have cardiovascular disease, but even heart-healthy people are at substantial risk. If you’re taking an NSAID and you have a history of heart disease, your risk for congestive heart failure (CHF) is increased 10-fold.
The latest diclofenac study2, led by David Henry of the Institute for Clinical Evaluative Sciences in Toronto, found diclofenac raises your risk of a heart attack or stroke by about 40 percent, compared to taking no NSAID. Since this study was a meta-analysis, it analyzed the results of multiple studies, some of which showed disturbingly high rates of cardiovascular events.
In a 2012 study published in Circulation, NSAIDs were associated with a persistently increased risk of coronary events in patients with a previous myocardial infarction (heart attack). In more than 43,000 MI patients, NSAID use was associated with a 59 percent increased risk of death after one year and a 63 percent increased risk of death after five years of use. In addition, the use of the NSAIDs was associated with an increased risk of coronary death and recurrent MI.3 Henry remarked:
"Clearly thousands of people die as a result of using [diclofenac]. But these are invisible victims. And therefore, there's no advocacy lobby group on their behalf."
No Dose Low Enough to be Safe
Diclofenac is now available in an over-the-counter product called Voltarol Pain-eze, which contains a lower dose of the drug than prescription strength. Even this lower dose resulted in a 22 percent increased risk of a cardiovascular event. Besides increasing blood pressure and clotting, there is now evidence that COX-2 inhibitors may cause hardening of the arteries as well, even in heart-healthy people.4 In fact, the researchers said they could not find ANY dose of this drug low enough to not significantly increase your cardiovascular risk!
In addition to the cardiovascular effects, the NSAIDs are associated with damage to the gastrointestinal tract, kidneys and liver, and have also been linked to hearing loss and miscarriage. The evidence is mounting to indict these drugs as some of the most damaging you can take! Your relative risk from NSAIDs is controlled by a number of factors. Your odds of having adverse effects increases if any of the following apply to you:
- Elderly or disabled
- History of peptic ulcer
- Concurrent prednisone or corticosteroid use
- Alcohol dependency or cigarette smoking
- Taking a high dose of the NSAID, or one of the more toxic NSAIDs
Inflammation Can Be Controlled Without Drugs
If you have an injury or infection, inflammation is a natural part of the healing process. Through a series of biochemical reactions, white blood cells and other chemicals are sent to the injured area to fight off foreign bodies. This inflammatory process can lead to pain, swelling, redness, warmth and loss of movement or function.
If you have pain from inflammation, there are ways to treat that pain using natural anti-inflammatory agents instead of drugs. These natural anti-inflammatories will benefit your heart and brain — unlike their pharmaceutical counterparts that can do more harm than good. For example, our revised and updated rheumatoid arthritis protocol has a 60 to 90 percent improvement rate for RA sufferers.
If you struggle with pain from inflammation, I urge you to avoid the use of NSAIDs like diclofenac, which are riddled with potentially dangerous health effects. Diclofenac is as dangerous as the ill-fated drug Vioxx that killed more than 60,000 people — yet diclofenac continues to be the most prescribed painkiller worldwide! When you look at these statistics, it is blatantly clear that you simply can’t rely on your physician to protect you. But you can be proactive and take charge of your own health.
Basic Lifestyle Factors that Must Be Addressed
Lifestyle changes will go a long way toward reducing inflammation in your body, so focus on addressing the following factors:
- Optimize your diet. Avoiding pro-inflammatory foods like trans fats, fried foods, processed foods, sugar and grains; reduce carbohydrates (sugar, grains, fructose) and protein, replacing them with high quality fats. Fifty to 70 percent of your total intake can be fat. Most of your diet should be fresh, whole foods, like organic vegetables and grass-pastured meats and dairy, and these beneficial fats, such as butter and fermented dairy from grass-pastured animals, cheese, egg yolks, and avocados.
Incorporate naturally fermented foods into your diet, working up to 4-6 ounces per day. One large serving of several ounces of optimally fermented foods can supply you with around 10 trillion beneficial bacteria, which is about 10 percent of the population of your gut. The best way to learn how to prepare them properly is to get the GAPS book or listen to my interview with Caroline Barringer. You can take a high quality probiotic supplement, but consuming the actual fermented foods provides the highest benefit.
- Get Grounded. Lack of grounding, due to widespread use of rubber or plastic-souled shoes, is likely contributing to chronic inflammation today. When you walk on the earth barefoot there is a massive transfer of beneficial electrons that serve as potent antioxidants. Experiments show that walking barefoot upon the Earth produces beneficial changes in your body, including decreased pain and inflammation. So, do yourself a favor and put your bare feet upon the sand or dewy grass to harness the healing power of the Earth.
- Get plenty of animal-based omega-3 fats. My favorite source is krill oil, which has compounds called resolvins and protectins that help quell inflammation. Krill oil also naturally contains astaxanthin — a powerful anti-inflammatory in itself. (Read more about astaxanthin in the next section.)
Exercise regularly. Exercise is a great way to lower inflammation — especially weight training, high intensity exercises, stretching and core work. Rheumatoid arthritis sufferers who did weight training for 24 weeks improved their function by 30 percent and their strength by 120 percent.
- Have good stress-busting outlets. High levels of stress hormones can cause your body to release more inflammatory chemicals, so be sure you are implementing some sort of stress management. Meditation, prayer, yoga, and Emotional Freedom Techniques (EFT) are all excellent stress management techniques, but you’ll have to find what works for you.
- Optimize your vitamin D levels. Your best source of vitamin D is through exposing your skin to the sun or using a safe tanning bed. Monitor your vitamin D levels to confirm that they are in a therapeutic range of 50-70 ng/ml. If you can’t get UV exposure, consider taking an oral vitamin D supplement.
Fighting Inflammation Naturally with Herbs and Supplements
The herbs and supplements that follow are useful for treating the symptoms of inflammation and relieving pain while you work at implementing the lifestyle changes above:
- Curcumin (active agent in the spice turmeric) is a potent anti-inflammatory shown to be effective against both acute and chronic pain. A study published in April 20125 revealed that a highly bioavailable form of curcumin was more effective than Voltaren (diclofenac) in alleviating RA symptoms, including tenderness and swelling of joints. In fact, the individuals taking curcumin experienced the most improvement across the board.
- Ginger has a number of health benefits, one of which is reducing inflammation. Ginger is a natural pain reliever and can be quite beneficial post exercise. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice.
- Astaxanthin is a powerful anti-inflammatory that has great pain controlling benefits. In one study, RA sufferers experienced a 35 percent improvement in pain levels, as well as a 40 percent improvement in their ability to perform daily activities after receiving astaxanthin for only eight weeks. In another study6, more than 80 percent of arthritis sufferers improved while taking astaxanthin.
- Boswellia, also known as boswellin or "Indian frankincense," is another herb I've found to be particularly useful for arthritis pain and inflammation.