pain relievers

Acetaminophen or aspirin are safer alternatives to manage pain than relying on ones like ibuprofen and naproxen, which can increase the risk of heart attack or stroke. [© Monkey Business Images | Dreamstime.com]

The U.S. Food and Drug Administration (FDA) recently announced it is “strengthening an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs)­—including ibuprofen, naproxen, diclofenac, and celecoxib as well as others—increase the chance of heart attack or stroke. The risk of heart attack and stroke with NSAIDs, both of which can lead to death, was first described in 2005 in the Boxed Warning and Warnings and Precautions sections of prescription drug labels.”

We knew that long-term use of NSAIDs increased the risk of heart disease and stroke, but this new study discovered that short-term use could also pose a significant threat. This warning is especially important for high-risk groups that include males over age 50, females over age 60 and those who have high-risk factors of developing coronary artery disease such as diabetes, high blood pressure, high cholesterol, smoking or obesity.

For my patients with diagnosed coronary artery disease, a stent, history of a heart attack or bypass surgery who are suffering from a headache, arthritis or backache, I recommend that they take NSAIDs for no more than a few days. If you are a high-risk cardiac patient, but have not had a cardiac event, you can take NSAIDs for a few weeks but no longer.

If you want to avoid the risks associated with NSAIDs, Tylenol (acetaminophen) or aspirin are safer alternatives to manage pain. If you have concerns, you should call your doctor to discuss your risk of taking NSAIDs versus the benefit they may have in treating your pain.

If you are taking NSAIDs and experience symptoms such as chest pain, shortness of breath or trouble breathing, weakness in one part or side of your body or slurred speech, call 911.

 


According to the FDA, new prescription NSAID labels will be revised to reflect the following information:

  • The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID.
  • The risk may increase with longer use of the NSAID. The risk appears greater at higher doses.
  • It was previously thought that all NSAIDs may have a similar risk. Newer information makes it less clear that the risk for heart attack or stroke is similar for all NSAIDs; however, this newer information is not sufficient for us to determine that the risk of any particular NSAID is definitely higher or lower than that of any other particular NSAID.
  • NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease. A large number of studies support this finding, with varying estimates of how much the risk is increased, depending on the drugs and the doses studied.
  • In general, patients with heart disease or risk factors for it have a greater likelihood of heart attack or stroke following NSAID use than patients without these risk factors because they have a higher risk at baseline.
  • Patients treated with NSAIDs following a first heart attack were more likely to die in the first year after the heart attack compared to patients who were not treated with NSAIDs after their first heart attack.
  • There is an increased risk of heart failure with NSAID use.
Keith Freidman, M.D., is a cardiologist with Cardiovascular Specialists of Central Maryland in Columbia.

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HCGH cardiac (heart health) team

Dr. Alexander Chudnovsky, director of Cardiac Rehabilitation Services at Howard County General Hospital, with (from left): Prasobha George, RN; and exercise physiologists Suzanne Jeffreys and Brett Goldberger. Dr. Chudnovsky is a cardiologist with Cardiovascular Specialists of Central Maryland in Columbia.

February is American Heart Month: Exercise to Tone Your Heart!

American Heart Month is a good time to remember how important exercise is for heart health. No matter what age you are or stage of life you are in, some form of exercise is beneficial for most people.

Alexander Chudnovsky, M.D., a cardiologist on staff at Howard County General Hospital (HCGH) and medical director of the hospital’s Cardiac Rehabilitation Program, wants you to know that exercise is for everyone, regardless of age or cardiac health status. The heart is meant to be used!

No Cardiac History?
Exercising doesn’t just tone the muscles in your arms, legs and core, it strengthens the heart muscle. According to the American Heart Association, physical activity helps prevent the nation’s number one and number four killers: heart disease and stroke. “When you exercise regularly, the heart becomes conditioned and uses oxygen and energy more efficiently,” says Dr. Chudnovsky. “To condition the heart, you should exercise at least four times a week and raise your heart to your target heart rate for 20 to 30 minutes during exercise.”

What is your target heart rate?
220 – your chronological age x 0.8 = your target heart rate.

The Cardiac Patient
In general, most cardiac patients benefit from exercise. Those with coronary artery disease and congestive heart failure can benefit significantly from cardiac rehabilitation offered in a clinical, monitored setting. You should discuss a cardiac program with your physician. HCGH offers many cardiac rehabilitation options to help those who have recently experienced a heart attack, angioplasty, stable angina, coronary bypass surgery, irregular heart rhythms, heart failure or transplant or valve surgery. Call 443-718-3000 for more information.

“Exercise can induce the heart to grow new blood vessels to supply areas of the heart that may have been affected by prior cardiac events,” notes Dr. Chudnovsky. “In addition, regular exercise can help reduce blood pressure, increase good cholesterol (HDL) and reduce bad cholesterol (LDL), improve glucose metabolism for those with diabetes and support weight loss.”

 

Before You Start: According to Dr. Chudnovsky, if you are planning to start exercising and you are not conditioned and have cardiac risk factors that include diabetes, smoking, high cholesterol, high blood pressure and/or a family history of cardiac events, you should see your cardiologist or primary care doctor before you put your heart under the stress of physical activity.

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calendar_2014smMonday, Oct. 20, 3:30 p.m. – 5:30 p.m. Blood Pressure Screening at Glenwood Branch. Free, walk-in blood pressure screening and monitoring offered by Howard County General Hospital: a Member of Johns Hopkins Medicine. No registration required.

Monday, Oct. 20, 3:30 p.m. Superfoods at Miller. Some foods promote health and longevity better than others. Licensed nutritionist Karen Basinger names these powerhouses and how to best use them. Register online or by calling 410.313.1950.

Tuesday, Oct. 21, 9 to 11:30 a.m. Diabetes Screening & BMI. Free. Held in Howard County General Hospital’s Wellness Center. Meet with an RN for a glucose blood test, BMI measurement and weight management information. Immediate resu­lts. Fasting eight hours prior recommended.

Tuesday, Oct. 21, 7 to 8:30 p.m. Choose Your Pediatrician and Promote Your Newborn’s Health. Free. Held in Howard County General Hospital’s Wellness Center. Learn factors to consider and questions to ask when choosing your pediatrician and ways you can promote your newborn’s health. Presented by Dana Wollney, M.D.

Thursday, Oct. 23, 7 to 9 p.m. Get Moving Again: Total Joint Replacement. Held in Howard County General Hospital’s Wellness Center. Free. Learn about total hip and knee surgery from health care professionals, past patients of our Joint Academy and Richard Kinnard, M.D.

Monday, Oct. 27, 5:30 p.m. to 9 p.m. Adult, Child and Infant CPR/AED in Howard County General Hospital’s Wellness Center. Cost is $55. This course will teach the skills needed to clear an airway obstruction, perform cardio-pulmonary resuscitation (CPR), and how to use an automated external defibrillator (AED).


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Saturday, Aug. 16, 10 a.m. – 12 p.m. Ask A Master Gardener. Discuss gardening questions and concerns at the Glenwood Branch. University of Maryland Extension – Howard County Master Gardeners. Also offered at the Miller Branch Saturday, Aug. 16, 10 a.m. – 12 p.m. and Aug. 18 7 – 8:30 p.m. No registration required.

Saturday, Aug. 16, 10 a.m. Compost Demonstrations. Master Gardeners discuss and demonstrate composting on a drop-in basis at the Miller Branch. Free bins provided for Howard County residents. University of Maryland Extension – Howard County Master Gardeners. No registration required.

Saturday, Aug. 16, 11 a.m. Crop Swap. Do you have an abundance of vegetables from your garden? Let’s crop swap! Bring homegrown produce to trade for something new and delicious at the Miller Branch. Share growing tips and favorite varieties. Families welcome. Leftovers donated to the Howard County Food Bank. Set up from 11 – 11:30 a.m., swap from 11:30 a.m. – 12 p.m. Registration is required. Register online or by calling 410.313.1950.

Saturday, Aug. 16, 3 p.m. Kindergarten, Here We Come. The Central Branch will have stories and activities to help mark that all important first day, including boarding a real school bus. For children entering Kindergarten this fall; 45- 60 min. Cosponsored by Friends of Howard County Library and Howard County Public School System. Registration is required. Register online or by calling 410.313.7880. Another is offered on Aug. 19 at 10:15 a.m. at the Savage Branch and again at 7 p.m., and also at 2 p.m. at the East Columbia Branch. Offered again on Aug. 20 at 10:15 a.m. at the Savage Branch and at the East Columbia Branch at 7 p.m. And offered Aug. 21 at 10:15 a.m. at the Savage Branch.

Monday, Aug. 18,  Blood Pressure Screening at Glenwood Branch – a Well & Wise Event. Free, walk-in blood pressure screening and monitoring offered by Howard County General Hospital: A Member of Johns Hopkins Medicine. Also offered, Tuesday, Aug. 12, 1 – 3 p.m. 

Monday, Aug. 18, 2 p.m. Infectious Diseases. Learn about infectious diseases, how they are spread, and how disease detectives work to find and stop their spread using medical technology and nanotechnology at the Savage Branch. Participate in mock disease outbreaks around the globe to learn to identify and handle some of the most dangerous diseases, select the right medical or nanotechnology methods, and develop a communication pack to let others know. Being an Infectious Disease Detective has never been more fun! Ages 11-18. HiTech is funded in part by a National Leadership Grant for Libraries from The Institute of Museum and Library Services. Visit hclibrary.org/hitech_events. Registration is required. Register online or by calling 410.313.0760. Offered again on Aug. 19 at 2 p.m. , Aug. 20 at 2 p.m., Aug. 21 at 2 p.m., and Aug. 22 at 2 p.m.

Monday, Aug. 25, 7 p.m. I’m Going to be a Big Brother or Sister. In partnership with Howard County General Hospital: A Member of Johns Hopkins Medicine. A Well & Wise class. Come to the Central Branch to prepare for the arrival of a baby in this class for new siblings. Enjoy stories, activities, and bring a favorite doll or stuffed animal to practice holding your baby. Resources for parents, too. Families; 30 – 45 min. Ticket required. Limited space; tickets available at Children’s Desk 15 minutes before class.

Tuesday, Aug. 26, 5 – 6:30 p.m. Weight Loss Through Bariatric Surgery in the Howard County General Wellness Center. Learn about weight loss surgery from Johns Hopkins Center for Bariatric Surgery. Register online or call 410-550-5669.

Tuesdays and Thursdays, Sept. 16 to Nov. 6, 6:30 – 8 p.m. Healthy Weight Connection. Kick-start individual lifestyle changes, including diet and exercise, to help you reach a healthier weight. Receive personalized guidance from a certified dietitian. Various nutrition topics and gentle yoga. Class held in the Howard County General Wellness Center. Cost is $195. Register online or call 410-740-7601.


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calendar_2014smMonday, Aug. 4, 6:30 p.m. Move with Games at Elkridge Branch – a Well & Wise Class. Exercise while competing with friends on the Wii or XBox Kinect. Healthy snack provided. Ages 11 – 17. No registration required.

Monday, Aug. 4 & 18, 3:30 p.m. – 5:30 p.m. Blood Pressure Screening at Glenwood Branch – a Well & Wise Event. Free, walk-in blood pressure screening and monitoring offered by Howard County General Hospital: a Member of Johns Hopkins Medicine. Also offered, Tuesday, August 12, 1:00 p.m. – 3:00 p.m. at Elkridge Branch. No registration required.

Tuesday, Aug. 26, 5 – 6:30 p.m. Weight Loss Through Bariatric Surgery Learn about weight loss sugery from Johns Hopkins Center for Bariatric Surgery. Call 410-550-5669.

 

 


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As we approach Mother’s Day, our gift to you is a primer on heart disease and women. According to the National Heart, Lung and Blood Institute (NHLBI), one in four U.S. women dies from heart disease.

Coronary heart disease, or atherosclerotic cardiovascular disease, occurs when plaque builds up in artery walls, narrowing them and making it harder for blood to flow through. If a blood clot forms, the blood flow can stop and cause a heart attack.

Signs and Symptoms

“Women tend to think of themselves as caregivers, but they also need to be care getters,” stresses Lili Barouch, M.D., a Johns Hopkins cardiologist on staff at HCGH. “Women should not ignore their symptoms, even if they don’t seem typical, because women with heart disease get a wider variety of symptoms than men. Although ‘classic’ heart disease symptoms include chest pain radiating down the left arm at rest or with exercise, women may only experience more atypical types of chest discomfort such as squeezing, burning or tightness, or even have no chest discomfort at all. Their ‘chest pain’ may feel like indigestion or acid reflux, nausea, cold sweats or they may only have shortness of breath. Women and men with diabetes often do not experience chest pain due to diabetic nerve damage; rather, they may just feel short of breath, nauseous and sweaty. If you aren’t sure, or if you sense something is wrong, see your doctor.”

Risk Factors

“In general, women have the same risk factors as men, but they may affect women differently from men,” says Dr. Barouch. “There are several risk factors for heart disease—including those you can’t control and those you can.”

  • Age and menopause. Estrogen provides women with some protection before menopause, so women who are 55 and younger have a lower risk compared to men. However, the risk for heart disease increases in both men and women after 55.
  • Women who undergo early menopause (before age 46) are at an increased risk.
  • Family history. Your risk for heart disease increases if your father or a brother was diagnosed with heart disease before 55 or if your mother or a sister was diagnosed with heart disease before 65. A family history of stroke—especially a mother’s stroke history—also can help predict the heart attack risk in women.
  • Preeclampsia during pregnancy, which occurs when women have a rise in blood pressure and excess protein in the urine.
  • Smoking
  • High cholesterol and triglyceride levels
  • High blood pressure
  • Diabetes/pre-diabetes
  • Overweight/obesity
  • Birth control pills
  • Physical inactivity
  • Unhealthy diet
  • Stress/depression
  • Sleep apnea

Weighing In on What Matters Most

“It is more important to be fit than thin. Even if you don’t lose weight, exercise improves cardiac efficiency and lowers blood pressure, blood sugar and cholesterol,” says Dr. Barouch. “Start by exercising at least three days a week and see what you can do comfortably. Don’t push yourself to exhaustion, or you will not sustain it. Pick a moderate exercise that you enjoy; once it becomes a habit, increase your time until you get to the goal of 30 minutes or more of exercise each day.”

According to NBLHI, inactive people are nearly twice as likely to develop heart disease compared to those who are physically active. In addition, a lack of physical activity can worsen other heart disease risk factors.

Via Howard County General Hospital’s Wellness Matters.


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