161- An Increasing Risk of Heart Attack with NSAID Use

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are back with the research. There is a really interesting paper that came out from the BMJ and it is titled Risk of Acute Myocardial Infarction with NSAIDS in Real World Use. So this is a really good one because many people who come into your practice are taking NSAIDs. It's probably one of our biggest quote unquote competitors. If we look at what people are taking or being prescribed that have muscular musculoskeletal complaints and the risks that they are taking, I have a feeling many people are unaware of. That's what we're gonna break down in today's episode. We're gonna talk about the research and bring it into the context of you and your practice as well. But before we get started, I'll say a few words about Rocktape. Rocktape is proud to be a sponsor of the evidence Based Chiropractor and they have revolutionized the soft tissue world again with new rock blades Mohawk. Featuring three tools in one, a surgical stainless steel hand polished tool, two attachments silicon sleeve and an obs comb. Mohawk Unlock never treatment protocols. You can pick them up for 175 bucks and see all the educational courses@rocktape.com Mohawk Additionally, one other bit of housekeeping before we dive in. I am super pumped. I was invited to join a online summit with Dr. Axe and a host of other really great chiropractors and non chiropractors and NFL athlete is actually involved as well and it's gonna be completely free. We're gonna talk about organic traffic, we're talking about Facebook ads. Me personally, I'm talk repurposing content for YouTube, Facebook and Instagram. You can check it out at socialhealthexperts.com it's completely free but you need to sign up to get access to everything. So head on over to social health experts, Dr. Jos Axe of Asian nutrition, a variety of other people, NFL star Andrew East, David Tuhill and others. Please join me. Head on over there. Socialhealthexperts.com join us. I'm really excited about what I got to talk about and I can't wait to hear about what everybody else has to say. As so Be sure to check that out. But for today's episode, again, we are talking about heart attacks, right? Acute myocardial infarctions with NSAID use. So I kind of teased this at the top, but I want to drill down a little bit farther. One of the most common things as we talk about relationship building within the context of the evidence based chiropractor, what we see time and time again is from a primary care or a GPS perspective, when they see a patient with a musculoskeletal complaint that don't have red flags, they are, which is less than 1% of individuals, thankfully. So 99% of the time, these GPs in primary cares are doing one of three things. For somebody that comes in with a musculoskeletal complaint, they are prescribing NSAIDs, they are referring to physical therapy, or they are referring to another specialist, a neurologist, an orthopedic, et cetera. Now, the neurologist and the other specialist is the minority of the time. These aren't equally distributed. So a majority of the time it's split between two things. Referral to PT or medication. Nsaids treating in house. So this is where this becomes very, this paper becomes very, very important for you and your pract because this is one of your largest competitors, if you want to think of it that way. The NSAIDS that somebody might take at home based upon just stopping at CVS or Walgreens or somewhere else and picking some up, or if they're being told to take NSAIDs by their medical doctor, which is probably the number one thing that primary cares and GPS do if they see somebody with musculoskeletal complaints. By the way, 30% of a GP or primary care's daily volume typically revolves around musculoskeletal complaints. So the amount of NSAIDs being prescribed is completely outlawed. Outrageous. But even with that, if it was a very safe and effective modality, well, okay, it might not be our choice, but it'd be on the table. But we're going to discover here there are some definite acute risks of heart attack associated with NSAID use. And quite frankly, I don't think this is being talked about enough or put into context that people have any clue that there is a high correlation or increased risk or likelihood of heart attack. The other interesting thing about this paper is that they looked at a cohort of nearly half a million individuals. So this was not a paper that looked at a sample size of 10 people, 100 people, 1,000 people, or even 10,000 or 100,000 people this looked at nearly half a million individuals across multiple research studies to put this data together. If you want to check out the paper itself, you can always access that by clicking down in the show notes and the title again was Risk of Acute Myocardial Infarction with NSAIDS in Real World Use. And this was a new paper as well. I believe this came out in 2017. So it is very, very new. I want to read a few quotes from the paper to give some context to what the researchers discovered and then we'll talk a little bit more about how you can utilize this information in your practice. So they found all NSAIDs, including Naproxen, were found to be associated with an increased risk of acute myocardial infarction. Okay, so that's pretty straight up. We already talked about that a little bit. I'm gonna go a step farther here. Researchers also found odds ratio point estimates of acute myocardial infarction for current use indicate an associated risk in increase of 20 to 50% overall, with possible increases of 75% for ibuprofen and naproxen. And they also found the probability of increased risk of myocardial infarction associated with use of an NSAID for one to seven days is 92 to 99%. It does not stop there. The researchers also found use for eight to 30 days at a high dose was particularly harmful for ibuprofen, naproxen. And finally, the researchers came to the conclusion of no surprise at this point. In summary, compared with non use of NSAIDs in the preceding year, we documented that current use of all studied NSAIDs, including Naproxen, were associated with an increased risk of acute myocardial infarction. So they also point out in the paper, when they're kind of discussing things early on, that this is a really a well known thing, although it hasn't been well documented. Now, when they say well known, they probably don't mean publicly, but they mean amongst physicians, researchers and clinicians. But again, I want to bring it back to the individuals. I want to get very pragmatic and talk about the people in your community, the people that you live with, your neighbors, your friends, and the people that you're seeing in your practice. Our utilization, and you hear me say this a lot, but it's the truth. Our utilization hovers around 15% at best. It's more likely around 10%. Yet 90 plus percent of individuals are gonna deal with a spinal complaint, a musculoskeletal complaint at some point in time. Nearly everybody where Are a lot of people going to. Well, if 30% of the daily volume of primary care docs revolves around musculoskeletal care, there's a lot of people going there that are never exposed to chiropractic. Now when we look at that, we take it one step farther and we say, what's that prim care gonna do? As we talked about at the top, there are three primary options that primary care physicians make or choose when they're dealing with people with musculoskeletal complaints and NSAIDs. Medication are at the top of that list. Secondarily is gonna be pt and down the road might be referral to another specialist. But that's what's happening a majority of the time. And quite frankly, it's unsettling to me to read papers like this when it's a cohort of a half million people. We're seeing stark increases in acute myocardial inf. And we're seeing, in my estimations, probably hundreds of millions, if not more NSAIDS being taken each and every year for musculoskeletal complaints. When all the research points to what we do as chiropractors being some of the most safe and effective options that somebody can go through with none of these absolutely outrageous risks associated with medications. And we didn't even dive into injections and surgery. And when that's done, too early in the process. So this is why I get so passionate about you reaching out to those other healthcare providers in your community. Do I think it's okay, boom for your practice? Yes. Is it easy? No. Does it happen right away? Quite often? Not. But you can usually find some quick wins with people you build relationships with quickly. But it's a long term play and it's a long term strategy. But in my opinion, even saving one person from potentially having acute myocardial infarction, a heart attack as a result of taking an NSAID is worth it. And if you're out there practicing and have not taken those steps to reach out to those people in your community, the other physicians, then I think there's a lot of responsibility on your shoulders to do so. Because getting out there to those other providers is going to open up a new window of opportunity for patients to come into your practice. You should aggressively market B2C business to consumer. You should do your online marketing, your SEO, maybe you're doing pay per click. There's a variety of things you can and should be doing, but don't do it at the expense of reaching out to other healthcare providers. Because there are people that you cannot reach, you cannot touch through your traditional channels, but that you will and can get access to by bridging the gap and building relationships with other healthcare providers in your community. And when the risks are as high as heart attacks associated with NSAIDs, that should be impetus enough to say, I'm going to take the next step. I'm going to use the long play and I'm willing to get out of my comfort zone, grow, stretch and bridge the gap to build relationships. The opportunities have never been better to do so. It certainly still takes some work. If you want to see a variety of free tools to help you do that, you can check out the free Tools section@the evidencebasedchiropractor.com and of course our membership at the evidencebasedchiropractor.com is where we help you go through everything one step at a time. Everything from building your target list to how do you execute to bridge the gap. Get referrals into your practice. Expose more people to chiropractic care, which is all great for you, but also very likely over time, literally save people's lives from advanced interventions that they may have been able to avoid that might have heightened risks for them. That's why it's so important. That's why I am so passionate about it. If you wanna check out more about this research paper, you can check out the show notes and again, if have the opportunity, head over to socialhealthexperts.com I am going to be on a, I guess a summit of sorts, a Digital Summit with Dr. Josh Axe and a variety of other docs. I'm gonna be talking about repurposing content. It's worth it to sign up just for Dr. Axe's information because he is running a huge healthcare business ultimately within our space and learning from him is well worth it. It's completely free, but if you get there too late, then you're not going to be able to get in. So be sure to check that out@socialhealthexperts.com I hope you have a great week in practice and I will talk to you soon.

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