Protecting your heart from pain

The heart can easily be affected by a host of factors - stress, lack of sleep, and especinily the medication that we take.

The heart is strained by many obvious vices, but did you know that your choice of painrelief can also play an important role?

By Dr AIZAI AZAN

Your heart is the hardest-working organ in your body in one day alone it beats over 100,000 times and pumps 8,000 (1900) gallons of blood. In an aver age lifetime, your heart will beat over three billion times.

As with all things that don't require a conscious effort, the heart's steady work is easily over looked. Despite its obvious strengths however, the heart can easily be affected by a host of factors - stress, lack of sleep, and especially the medication that we take.

One of the most fundamental lessons for patients to learn is that all medication has the potential of causing side effects; in studies, even patients in control groups who are consuming placebos report that they experience side effects!

The objective of medication is to alleviate symptoms (such as the aches and pains associated with fever) and prevent a given condition from progressing further (such as diabetes or hypertension). Seen in this fight, there are clear benefits of treating a disease. The challenge lies in finding suitable treatment options where the benefits clearly outweigh the risks, ie side effects.

One of them was linked with increased risk for heart attack and stroke over long-term use.

As such, experts from around the world, including the American Heart Association. recommend that
the benefits and risks of NSAIDs are carefully weighed before being prescribed to patients. In addition, the recommendations stress that NSAIDs should be used at the lowest possible dose for the shortest duration necessary.

While this may seem extreme, consider that:
1. Evidence continues to grow that NSAIDs as a class contribute to increased risk for heart attack
(myocardial infarction. MI) and may aggravate chronic heart failure with increased risk of hospitalisation.

2. The evidence suggests that NSAIDs should be used with caution in people at risk of cardiovascular events, including patients with a history of chronic heart disease. hypertension, the elderly and those
taking anti-hypertensive or diuretic medication.

3. Many of the risk factors for NSAID-ralated side effects are associated with age-related chronic conditions, thereby increasing the risk of drug interactions in the elderly. Any NSAID use in high risk patients (for the long term) should be accompanied with protective measures such as low dose aspirin,and proton pump inhibitors should also be prescribed, and the patient should he closely monitored for elevated blood pressure, development of oedema and deterioration of renal function.

Despite greater awareness of healthcare issues, these facts are often overlooked or misunderstood, and in a dramatic reversal, has led to a backlash that has resulted in some people exercising a general mistrust of all pain relievers for fear of side effects, even though they may benefit from pain relief. instead of suffering in silence however, a better option is to speak to doc tars to gain a clearer understanding of the different types of pain relievers and which ones have an established safety profile.

For example, paracetamol has been safely used for decades, demonstrating that it is well tolerated across a wide range of patients, including the elderly and those with high risk cardiovascular events.

Specifically, patients with heart disease need to carefully consider their use of pain relief. For example, patients who take low dose aspirin to reduce the risk of heart attack and strokes need to be aware that a single dose of ibuprofen negates the protective effects of the aspirin by blocking its anriplatelet effects. In contrast, paracetamol has no such blocking action, making paracetamol the safer and more suitable option.

In conclusion, the best rule of thumb to follow is to use the drug with the fewest known risks. Some
suggestions that may help:

• Always know the name of the medication that you are taking.
• Be aware that some over-the-counter formulations for cold and flu may contain NSAIDs.
• Avoid taking any medication for a long period without first consulting a doctor - over the counter pain medications should not be taken for more than 10 days at a time.
• Alternatives for pain relief such as paracetamol, should be considered for patients with cardiovascular risk