NSAID painkillers linked to increased heart risk

Ibuprofen tablet Ibuprofen: Used to treat inflammation

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Taking certain painkillers daily for some years carries a small increased risk of heart attack and stroke, research has suggested.

The findings relate to non-steroidal anti-inflammatory drugs like ibuprofen prescribed long-term to treat painful conditions such as arthritis.

People taking them now and again are at minimal risk, say experts.

The report, published in the British Medical Journal, looked at more than 100,000 patients in 31 clinical trials.

A Swiss team analysed data from existing large-scale studies comparing use of non-steroidal anti-inflammatory drugs (NSAIDs) - naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib and lumiracoxib - with other drugs or placebo.

One of the drugs - rofecoxib (also known by its brand name, Vioxx) was withdrawn in 2004 when other studies found a raised risk of heart attacks.

Start Quote

This confirms what has been known for some years now - taking non-steroidal, anti-inflammatory drugs on a regular basis increases heart attack or stroke risk”

End Quote Professor Peter Weissberg British Heart Foundation

Most of the patients were elderly, with conditions like osteoarthritis, and were taking high doses of NSAIDs daily for at least a year.

The researchers found the medicine increased the risk of death from stroke or heart attack by between two and four times, compared with placebo.

Peter Juni, professor of clinical epidemiology at the University of Bern, Switzerland, told the BBC: "For elderly (people) with musculoskeletal pain there must be extreme care when prescribing or taking these drugs."

But he stressed that the findings did not relate to people taking anti-inflammatories now and again for symptoms such as period pain or sports injuries.

Commenting on the research, the British Heart Foundation said anyone worried about their medication should speak to their doctor.

Medical director Professor Peter Weissberg said: "This confirms what has been known for some years now - taking non-steroidal, anti-inflammatory drugs on a regular basis increases heart attack or stroke risk.

"However, some patients with debilitating joint pains may consider the small increased risk worthwhile when set against the improvement in their quality of life that these drugs bring.

The data

  • Elderly people with chronic musculoskeletal conditions have a 1% risk over one year of heart attack/stroke
  • When taking NSAIDs, the risk is raised to 2-4%
  • The trials included 116,429 patients
  • In 29 trials there was a total of 554 heart attacks, in 26 trials there were 377 strokes and in 28 trials there were 676 deaths
  • Source: BMJ study

"Anyone who needs regular painkillers should talk to their doctor about which drug is the most appropriate for them. There is lots than can be done to mitigate any potential risks."

These comments were echoed by Simon Maxwell, Professor of Clinical Pharmacology at the University of Edinburgh.

Professor Maxwell said: "The advice to the public should continue to be to take this class of drugs only when they are genuinely necessary to control pain and in the lowest effective dose, not only because of any cardiovascular risk but also because of potential effects on the stomach."

A spokeswoman for the Medicines and Healthcare products Regulatory Agency (MHRA) said patients should not be alarmed about the results from the study.

"Any patients with questions about their current anti-inflammatory treatment should speak to their pharmacist, doctor or nurse at their next routine appointment," she said.

"Traditional NSAIDs and the newer COX-2 inhibitors are extremely important medicines to treat arthritis and other painful conditions, and for most patients the risks of side effects are outweighed by the benefits."

Annual review

COX-2 inhibitors are a new generation of NSAID drugs, which include celecoxib and rofecoxib.

Medical director of Arthritis Research UK Professor Alan Silman said: "Far fewer GPs are now prescribing NSAIDs and COX-2 to their arthritis patients, particularly those with cardio-vascular problems, because of the potential risks, yet for many people who are not at high risk of heart attacks and strokes they remain a highly effective means of combating pain.

"We would advise people with arthritis to seek an annual review of their painkillers with the GP so their risk of cardio-vascular risk can be regularly checked, and so that they can seek advice about alternatives to NSAIDs."

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