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Tag: cardiac arrest

Published on Leave a comment on Ibuprofen Use and Cardiac Arrest Risk?

A new study has been released that reminds us that all drugs (whether prescription or non-prescription) have side-effects.  This time a nation wide study from Denmark found that short-term use of the non-steroidal anti-inflammatory drugs (NSAIDs) ibuprofen (e.g. Advil and Motrin) and diclofenac is linked to a higher risk of cardiac arrest (the heart suddenly stops beating). It was an observational study so can't definitely say that ibuprofen and diclofenac caused the cardiac arrests, but the findings match a growing body of evidence.

Since Ibuprofen and other NSAIDs are popular non-prescription medicines used worldwide, people assume they are safe to use. In Denmark, ibuprofen is the only NSAID sold as an over-the-counter drug, and only in small amounts. In the U.S., both ibuprofen and diclofenac are sold in both non-prescription and prescription forms.

In the study, they found an increased risk of cardiac arrest in ibuprofen and diclofenac users. However, they did not find a risk of cardiac arrest with the use of COX-2 selective inhibitors, rofecoxib and celecoxib, nor with the NSAID naproxen. One of the researchers (Dr. Gislason) therefore advises consumers to try to avoid diclofenac, to limit the use of ibuprofen to no more than 1200 mg per day, and that perhaps the safest is naproxen (up to 500 mg per day). From Medical Xpress:

'Harmless' painkillers associated with increased risk of cardiac arrest

Painkillers considered harmless by the general public are associated with increased risk of cardiac arrest, according to research published today in the March issue of European Heart Journal - Cardiovascular Pharmacotherapy.....The current study investigated the link between NSAID use and cardiac arrest. All patients who had an out-of-hospital cardiac arrest in Denmark between 2001 and 2010 were identified from the nationwide Danish Cardiac Arrest Registry. Data was collected on all redeemed prescriptions for NSAIDs from Danish pharmacies since 1995. These included the non-selective NSAIDs (diclofenac, naproxen, ibuprofen), and COX-2 selective inhibitors (rofecoxib, celecoxib).

A total of 28 947 patients had an out-of-hospital cardiac arrest in Denmark during the ten year period. Of these, 3 376 were treated with an NSAID up to 30 days before the event. Ibuprofen and diclofenac were the most commonly used NSAIDs, making up 51% and 22% of total NSAID use, respectively. Use of any NSAID was associated with a 31% increased risk of cardiac arrest. Diclofenac and ibuprofen were associated with a 50% and 31% increased risk, respectively. Naproxen, celecoxib and rofecoxib were not associated with the occurrence of cardiac arrest, probably due to a low number of events.

"The findings are a stark reminder that NSAIDs are not harmless," said Professor Gislason. "Diclofenac and ibuprofen, both commonly used drugs, were associated with significantly increased risk of cardiac arrest. NSAIDs should be used with caution and for a valid indication. They should probably be avoided in patients with cardiovascular disease or many cardiovascular risk factors." NSAIDs exert numerous effects on the cardiovascular system which could explain the link with cardiac arrest. These include influencing platelet aggregation and causing blood clots, causing the arteries to constrict, increasing fluid retention, and raising blood pressure. [Original study.]

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There have been a number of recent studies finding various harms from air pollution - both for children and adults.The following are all from Science Daily:

Living near major roads may increase risk of sudden cardiac death in women

Living near a major road was associated with an increased risk of sudden cardiac death in women. Environmental exposure may increase heart disease risk as much as smoking, poor diet or obesity.

In 523 cases of sudden cardiac death, living within 50 meters (164 feet) of a major road increased the risk of sudden cardiac death by 38 percent, compared to living at least 500 meters (.3 miles) away. Each 100 meters (328 feet) closer to roadways was associated with a 6 percent increased risk for sudden cardiac death.

Air pollution harmful to young brains, study finds

Pollution in many cities threatens the brain development in children. Findings from a recent study reveal that children living in megacities are at increased risk for brain inflammation and neurodegenerative changes, including Alzheimer's or Parkinson's disease.

The study found when air particulate matter and their components such as metals are inhaled or swallowed, they pass through damaged barriers, including respiratory, gastrointestinal and the blood-brain barriers and can result in long-lasting harmful effects..."We asked why a clinically healthy kid is making autoantibodies against their own brain components," Calderón-Garcidueñas said. "That is indicative of damage to barriers that keep antigens and neurotoxins away from the brain. Brain autoantibodies are one of the features in the brains of people who have neuroinflammatory diseases like multiple sclerosis."

High-pollution days linked to increased risk of cardiac arrest

Rates of out-of-hospital cardiac arrest are elevated after days with high levels of air pollutants, reports a Japanese study. For example, 48 to 72 hours after days with high levels of particulate air pollution, the risk of out-of-hospital cardiac arrest increased by 17 percent, the researchers report.

Strong link between higher levels of pollution, lung health of European citizens

New data has identified a clear link between higher levels of exposure to air pollution and deteriorating lung health in adult European citizens. This study confirms previous findings that children growing up in areas with higher levels of pollution will have lower levels of lung function and a higher risk of developing symptoms such as cough and bronchitis symptoms. The new study also identified that people suffering from obesity are particularly vulnerable to the negative effects of air pollution, possibly due to an increased risk of lung inflammation.

Air pollution linked to irregular heartbeat, lung blood clots

Air pollution is linked to an increased risk of developing an irregular heartbeat -- a risk factor for stroke -- and blood clots in the lung, finds a large study. The evidence suggests that high levels of certain air pollutants are associated with a higher risk of cardiovascular problems, but exactly how this association works has not been clarified.

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Different than my usual post, but oh so interesting. From Science Daily:

Near-death experiences? Results of the world's largest medical study of the human mind and consciousness at time of death

The results of a four-year international study of 2060 cardiac arrest cases across 15 hospitals concludes the following. The themes relating to the experience of death appear far broader than what has been understood so far, or what has been described as so called near-death experiences. In some cases of cardiac arrest, memories of visual awareness compatible with so called out-of-body experiences may correspond with actual events. A higher proportion of people may have vivid death experiences, but do not recall them due to the effects of brain injury or sedative drugs on memory circuits. Widely used yet scientifically imprecise terms such as near-death and out-of-body experiences may not be sufficient to describe the actual experience of death. The recalled experience surrounding death merits a genuine investigation without prejudice.

In 2008, a large-scale study involving 2060 patients from 15 hospitals in the United Kingdom, United States and Austria was launched. The AWARE (AWAreness during REsuscitation) study, sponsored by the University of Southampton in the UK, examined the broad range of mental experiences in relation to death. Researchers also tested the validity of conscious experiences using objective markers for the first time in a large study to determine whether claims of awareness compatible with out-of-body experiences correspond with real or hallucinatory events.

Dr Sam Parnia, Assistant Professor of Critical Care Medicine and Director of Resuscitation Research at The State University of New York at Stony Brook, USA, and the study's lead author, explained: "Contrary to perception, death is not a specific moment but a potentially reversible process that occurs after any severe illness or accident causes the heart, lungs and brain to cease functioning. If attempts are made to reverse this process, it is referred to as 'cardiac arrest'; however, if these attempts do not succeed it is called 'death'. In this study we wanted to go beyond the emotionally charged yet poorly defined term of NDEs to explore objectively what happens when we die."

Thirty-nine per cent of patients who survived cardiac arrest and were able to undergo structured interviews described a perception of awareness, but interestingly did not have any explicit recall of events. "This suggests more people may have mental activity initially but then lose their memories after recovery, either due to the effects of brain injury or sedative drugs on memory recall," explained Dr Parnia, who was an Honorary Research Fellow at the University of Southampton when he started the AWARE study.

Among those who reported a perception of awareness and completed further interviews, 46 per cent experienced a broad range of mental recollections in relation to death that were not compatible with the commonly used term of NDE's. These included fearful and persecutory experiences. Only 9 per cent had experiences compatible with NDEs and 2 per cent exhibited full awareness compatible with OBE's with explicit recall of 'seeing' and 'hearing' events.

One case was validated and timed using auditory stimuli during cardiac arrest. Dr Parnia concluded: "This is significant, since it has often been assumed that experiences in relation to death are likely hallucinations or illusions, occurring either before the heart stops or after the heart has been successfully restarted, but not an experience corresponding with 'real' events when the heart isn't beating. In this case, consciousness and awareness appeared to occur during a three-minute period when there was no heartbeat. This is paradoxical, since the brain typically ceases functioning within 20-30 seconds of the heart stopping and doesn't resume again until the heart has been restarted. Furthermore, the detailed recollections of visual awareness in this case were consistent with verified events.

Thus, while it was not possible to absolutely prove the reality or meaning of patients' experiences and claims of awareness, (due to the very low incidence (2 per cent) of explicit recall of visual awareness or so called OBE's), it was impossible to disclaim them either and more work is needed in this area.