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High Doses of Common Painkillers Can Increase Heart Attack Risks

May 30, 2013

British researchers have published a study showing that long-term high doses of painkillers such as ibuprofen and diclofenac pose heart attack risks as great as those for the prescription painkiller Vioxx, which was withdrawn from the market over safety concerns.

In an article in the medical journal The Lancet, the researchers presented the results of a large international study of non-steroidal anti-inflammatory painkillers (NSAIDs), Reuters reports. High doses of these drugs increase the risk of a heart attack, a stroke, or dying from cardiovascular disease, by about a third. This means that for every 1,000 people with average heart-disease risk who take high-dose diclofenac or ibuprofen for a year, there would be about three additional avoidable heart attacks, one of which would be fatal, the researchers said. This risk is similar to that of COX-2 inhibitors or coxibs, a newer class of NSAIDs, which includes Vioxx. Merck withdrew Vioxx from the market in 2004 because of heart risks, Reuters reports.

Colin Baigent of the clinical trial service unit at Oxford University, who led the study, said that coxibs, ibuprofen, and diclofenac all pose similar risks for the user. But Baigent stressed that the heart risks involve people who need to take high doses of painkillers – 150mg of diclofenac or 2400mg of ibuprofen a day, for example – for long periods. A short course of an NSAID to treat a muscle strain is not likely to prove hazardous, Baigent said.

The research team analyzed data from 639 previously conducted randomized trials of NSAIDs. More than 300,000 people were involved in these studies. In contrast to the other findings, high doses of the NSAID naproxen did not appear to increase heart attack risk, possibly because of protective effects that balance out any extra heart risks, Reuters reports.

Because NSAIDs are effective in reducing joint pain and swelling, allowing many arthritis patients “to enjoy a reasonable quality of life," Baigent said, physicians “must be careful about the way we present the risks of these drugs.” Patients should not change treatment without consulting a doctor, he said.

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