LASIX

EXTRA, EXTRA, READ ALL ABOUT IT!

On December 6, 2022, the USTA provided its readers with an article (appearing after the ### of this article), written by Dr. Doug Daniels, president of the National HBPA and an equine practitioner who owns Virginia Equine regarding whether or not Lasix contributes to the sudden death in racehorses. From what I have read on the USTA website, I have gotten the opinion they are advocates for the use of Lasix. If I am wrong, I apologize.

I have read many opinions regarding Lasix from many professionals based on their scientific research. However, I am still in the dark regarding the sudden deaths of several Standardbreds. Rather than the USTA cherry-picking research that suits their agenda, I am CHALLENGING them to literally investigate the cause(s) of the sudden deaths of these Standardbreds:

TWICE AN ANGEL (Dragon Again) who suddenly fell at Monticello Raceway during the 3rd race on 3/22/2021. TWICE AN ANGEL did not finish and was euthanized after breaking down. The trainer of record was Philip “Bo” Sowers. Thank you TWICE AN ANGEL for your service!
FOX VALLEY ADELE (Lazarus), trained by $100,000,000. winning trainer Erv Miller, fell to her death at the Meadowlands on July 22, 2022. In her prior race she had paced in 1:52, home in 25 4/5, and finishing second. Super performance! Yet, in her following race, trainer Miller put her on Lasix for the first time. Sudden death. Thank you FOX VALLEY ADELE for your service!
NEVERMIND a two-year-old Trixton colt, Yannick between the shafts, dropped dead in the post parade at Lexington on September 19, 2022, at the Red Mile. Upon my investigating the horse’s owner, Nicholas Roussel, I discovered he was fined for “excessive or indiscriminate use of the whip” when he drove NEVERMIND on June 27, 2022, at Oak Grove. Thank you NEVERMIND for your service!
CABERNET is the last, but not least. On November 1, 2022, as I was watching the races at Hollywood Dayton, in Race 8, I noticed a horse struggling when leaving the gate. It was #5 Cabernet, driven by Mitch Cushing and trained by Larry Finn. A few yards later she fell over – dead. A five-year-old Cam’s Card Shark, CABERNET had 83 starts (11-8-10) with earnings of $100,108. Thank you CANERNET for your service!

Researching the cause of these deaths gives members of the USTA case-by-case information rather than scientific mumbo-jumbo. Hopefully the scientists who did the necropsies were honest experts on a mission to help our industry know what the causes are of sudden death. A prominent location on your website where this information could be found would be professional.

If I have a horse in tonight that bleeds, should I give it Lasix and hope it doesn’t kill it, or should I let it bleed? Maybe I should scratch it and begin an exercise program designed to strengthen the vessels, or maybe I should sell it. The USTA must help us answer these questions.

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The following article was published on the USTA website on December 6, 2022.

Be factual – not click-bait – trying to tie sudden death to Lasix

December 6, 2022,

Editor’s Note: The following is written by Dr. Doug Daniels, president of the National HBPA and an equine practitioner who owns Virginia Equine. He owns and breeds Thoroughbred racehorses.

Lexington, KY — After reading both the Bennet and Parkin article published in the Journal of the American Veterinary Medical Association entitled “Fifteen risk factors associated with sudden death in Thoroughbred racehorses in North America (2009–2021)” followed by the TDN (Thoroughbred Daily News) analysis of that article, I have become increasingly aggravated over the last three weeks from the implied message portrayed by each.

National HBPA President Doug Daniels DVM (right) and NHBPA CEO Eric Hamelback. Gwen Davis/Davis Innovation photo.

The dramatic click-bait headline “Horses on Lasix at Increased Risk of Sudden Death” is unwarranted by the facts. When compared to the end of the article, one becomes more frustrated with the headline since the statement “Further work is required to determine which, if any, clinical signs are potential indicators and, indeed, whether such a rare outcome could be reliably predicted” provides more realistic information than the sensationalistic title.

The authors of the JAVMA paper claim no conflict of interest, but it is funded by the Grayson Jockey Club Foundation, and “help in interpreting the Equine Injury Database” was provided by two long time employees of The Jockey Club. The Jockey Club has a long history of both funding Lasix research and also pressuring the recipients of this funding to interpret findings in a manner consistent with their long-held goal of the elimination of race-day administration of Lasix in American racing.

My first concern: “Sudden death” as defined in this paper deviates from accepted definitions. Exercise associated sudden death (EASD) is typically defined as acute death in an apparently healthy animal within 1 hour of exercise. Bennet and Parkin define sudden death as any horse that perished from non-musculoskeletal causes within 72 hours of racing, using five “codes” unique to the Jockey Club’s Equine Injury Database (EID). Left undefined are the facts behind how a horse becomes classified into one of these categories.

Even the authors of the paper agree that “it would be reasonable to assume that several of the listed codes would not be accurate.” By the authors’ own admission, using the EID with undefined codes that may have very different meanings in different jurisdictions result in conclusions that are not accurate.

More importantly, only 5.6% of the horses in this study started without Lasix. No effort is made on the part of the authors to determine what, if any, other factors are associated with not using Lasix. For example, they have determined that older horses are at higher risk of EASD, and this age group also consists of almost all horses who race on Lasix. The younger age group is the only age group where any number of horses can be found that race without Lasix.

The bigger question — completely ignored by the authors and their study funded by the Jockey Club — is why do horses in North America suffer EASD at a substantially lower rate than their counterparts in other parts of the world? In this paper, EASD (with all the caveats previously mentioned about its definition) occurs at a rate of 0.13/1,000 starts, which is close to 10% of the total deaths of racehorses. In Australia, this rate is more like 25% of the total, with a whopping 37% of these EASD a result of Exercise Induced Pulmonary Hemorrhage (EIPH). In a similar study in the United Kingdom, published by the same researchers in 2011, the rate of EASD was 0.3/1,000 starts.

Bennet and Parkin — of all people, being well familiar with the principles of epidemiology — should know full well that correlation does not equal causation. Yet, they offer in the conclusions of their paper that “The association between furosemide and sudden death prompts further study to understand which biological processes could contribute to this result.”

What we do know however, is the presentation of information can greatly impact the public’s reaction, as we have seen in these recent headlines. As presented in the TDN article and others on this topic, the odds ratio was presented as furosemide increases the risk of sudden death in horses by 62%. Yet as noted by James C. Meyer DVM MSc in his recent paper, if stated as an increase in the absolute risk, it would be 0.005%. That figure as you can see does not have the sensationalized purposeful negative effect as saying 62%.

I implore the readers of this op-ed along with the authors of the JAVMA article to consider that the biological process is simply the passage of time. The most obvious association between Lasix and EASD is that the majority of horses not racing on Lasix during the time of their study were 2-year-olds.

We know there is a mountain of evidence demonstrating that Lasix mitigates EIPH. When combined with further evidence that EIPH remains the most common cause of EASD in other countries, it is beyond irresponsible to use this Jockey Club-funded study as the basis for any policy intended to safeguard the health and welfare of our racehorses.

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LASIX! Know What You Believe and Why You Believe It

By Tim Finley

This tutorial is primarily being presented for my Standardbred racing friends, although Lasix is used in all competitive horse breeds in the U.S. Outside the United States, Lasix is often permitted for training but not given on race day because of its unclear effect on performance.

What is Lasix? Lasix, also known as furosemide and described as an anti-bleeding medication, is used by veterinarians in horse racing to prevent respiratory bleeding in horses running at high speed. Blood entering the lungs during high physical activity can cause a pulmonary hemorrhage and sometimes result in death.

The discussion of Lasix is probably one of the most prevalent discussions in Standardbred racing circles, plus the most controversial. The problem is that many have a biased opinion based on their desire to profit from its use rather than considering the harm it could cause the horse – that is if it is harmful to the horses. Perhaps it is good, but perhaps bad. Whichever is the case, you should have an opinion based on science.

In my quest for the truth, I realized the truth may conflict with the truth, depending on who you ask. I read dozens of articles published by experts, plus relied on my favorite source of Internet information – YouTube. It was a laborious effort, which I feel compelled to share with you. I had to hunt and hunt and hunt. I wish the USTA would begin to have sections of their website in which controversial subjects, problems, and other information regarding the industry is discussed by experts. I really feel they are remiss at confronting problems within the Standardbred industry.

Rather than present you with hundreds of pages of printed research, I am providing you with an abundance of YouTube videos which can be viewed at your convenience. That is, all except a recent article, By Frank Angst, October 25, 2022, that appeared on the BLOODHORSE website titled: JAVMA Paper: Lasix Among Risk Factors in Sudden Death. The paper’s co-author, Tim Parkin, is a veterinary epidemiologist who has consulted on EID.

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JAVMA Paper: Lasix Among Risk Factors in SUDDEN DEATH

Paper’s co-author Tim Parkin is a veterinary epidemiologist who has consulted on EID.

By Frank Angst, as seen on BLOODHORSE online magazine October 25, 2022

A paper published in the current edition of The Journal of the American Veterinary Medical Association calls for further study of an association between the use of Lasix in racehorses and sudden death.

The paper, “Fifteen Risk Factors Associated with Sudden Death in Thoroughbred Racehorses in North America (2009-2021),” is written by Euan D. Bennet and Tim Parkin. The paper is included in the edition of the JAVMA published Oct. 20.

Lasix (the diuretic furosemide), which has been allowed on race day in North America to prevent or reduce the severity of exercise-induced pulmonary hemorrhage, was among the 15 risk factors significantly associated with sudden death. It found that “horses racing while on furosemide medication were at 62% increased odds of sudden death.”

In observing those numbers in the study, the paper calls for further study.

“The association between furosemide and sudden death prompts further study to understand which biological processes could contribute to this result,” the paper notes.

Under current medication rules, most horses in the U.S. are permitted to race on Lasix, and the majority of trainers elect to treat their horses with it. The most common exceptions of horses that race without it are 2-year-olds and stakes competitors. Numerous racing jurisdictions prohibit the use of race day Lasix for those types of horses.

The paper finds that other factors associated with sudden death include a horse’s age and sex, purse of the race, race distance, and a horse’s recent history of injury or lay-up.

“Associations found between previous injury and sudden death suggests pre-existing pathology could contribute in some cases,” the paper notes.

The study relied on The Jockey Club’s Equine Injury Database, and Parkin is an England-based veterinary epidemiologist who has consulted on the EID since its inception. Through a study of the EID, the industry has made a number of changes in different areas to help reduce catastrophic musculoskeletal injuries, which since 2009 have accounted for the vast majority of equine deaths during racing.

While sudden deaths not related to musculoskeletal injury account for just 7.4% of all fatal incidents, the industry has improved safety through a step-by-step process as opposed to a silver bullet. On the musculoskeletal side, this has included changes in medication rules, claiming rules, purse guidelines, and increased efforts to improve surface safety—just to name a few. Many of these changes were put in place to address risk factors that were identified through the EID.

This step-by-step approach has helped racing reduce equine fatalities 30.5% since 2009. The rate of 1.39 per 1,000 starts in 2021 is a record low for the industry dating to 2009, when it started tracking rates. Another way of phrasing this number is that in 2021 equine fatalities did not occur in 99.86% of starts.

As these step-by-step changes have reduced musculoskeletal injury, Parkin, who heads the University of Bristol’s veterinary school, sees potential to make further equine safety progress by addressing the smaller subset of sudden deaths—non-musculoskeletal injuries. Since 2009 these sudden deaths have occurred at a rate of 0.13 per 1,000 starts. In June, at the Welfare and Safety of the Racehorse Summit at Keeneland | BloodHorse.com Track Profile”>Keeneland, Parkin outlined some of the sudden-death findings that appear in the paper.

He noted that as some high-profile horses have suffered sudden deaths in recent years, the problem has moved more into the public eye. In December, disqualified Kentucky Derby Presented by Woodford Reserve (G1) winner Medina Spirit died after a workout at Santa Anita Park. The California Horse Racing Board later announced that a necropsy could not precisely determine why the grade 1-winning colt collapsed and died after a Dec. 6 workout but said results suggested acute heart failure, without confirmation.

While neither the CHRB nor Parkin addressed any link between Lasix use and Medina Spirit’s sudden death, it was one of two medications in his system at the time of his passing. The CHRB reported that omeprazole, an anti-ulcer medication, and Lasix were detected in blood and urine samples. These findings were consistent with the medication report filed with the CHRB by the colt’s attending veterinarian.

Many horses are treated with Lasix before timed workouts.

Beyond high-profile instances of sudden death, the EID numbers show there has not been the same steady decline in the number of sudden deaths as seen in the musculoskeletal injury numbers since 2009. Parkin said this has resulted in sudden deaths becoming a larger proportion of equine deaths in racing—topping 10% of all equine deaths in racing in several recent years.

“People are noticing it more on the track,” Parkin said, adding that compared with catastrophic breakdowns where the problem is clear, it’s not always fully understood what the exact cause of death is in horses listed in the sudden death category.

Parkin outlined the association between Lasix and instances of sudden death revealed by the EID.

“We identified for the first time a relationship between the use of Lasix in the racehorse and sudden death,” Parkin said. “The use of Lasix in a race increases the risk by about 62%.”

Parkin acknowledged that even with regulatory changes in recent years that have seen more horses run without race-day Lasix, the EID numbers are comparing a large number of horses racing on Lasix with a relatively small number of horses racing without the diuretic. That said, he was confident that the EID numbers—which showed horses racing with Lasix experiencing sudden death at that 62% higher rate than horses who raced without it—are statistically relevant.

“I think that there is evidence that there is some sort of physiological relationship, potentially, between the use of Lasix and sudden death,” Parkin said. “It certainly warrants further investigation.”

Parkin said before the industry compiled such information in the EID, such relationships were elusive.

“I think the reason this wasn’t identified before is purely related to statistical power,” Parkin said. “This is purely driven by the fact that we now have sufficient number of years of data—starts and sudden deaths in the database—to enable us to draw this conclusion.”

At the safety summit, Parkin said he looks forward to finding out more about the impact of exercising or racing horses on Lasix, how that changes their blood chemistry, and perhaps contributes to the risk of cardiac arrhythmia.