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New Study Links Common Painkillers with Heart-Attack Risk

Jun 9, 2005 | Daily News Central

Ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDS) may increase the risk of heart attack, according to research published in this week's BMJ.

Patients should not stop taking the drugs involved, the authors caution, but further investigation into these treatments is needed, they say.

In the biggest study of its kind to date, researchers identified 9,218 patients across England, Scotland and Wales who suffered a heart attack for the first time over a four-year period. Patients ranged in age from 25 to 100.

The investigators looked at the prescribing patterns for these patients, tracking whether and when they had been prescribed NSAIDS. This class of medications, which commonly are prescribed to relieve inflammation and pain, includes ibuprofen, diclofenac (Advil, Motrin, etc.), naproxen (Aleve, Nuprin, etc.), celecoxib (Celebrex) and rofecoxib (Vioxx) plus a host of other less commonly prescribed anti-inflammatories.

Rofecoxib is no longer commercially available, having been withdrawn from the market in 2004. NSAIDS Increased Risk

The findings were adjusted to allow for several other heart-attack risk factors including age, obesity and smoking habits. Importantly, the researchers also adjusted for whether patientd already suffered from heart disease or were prescribed aspirin.

For those who were prescribed NSAIDS in the three months just before the heart attack, the risk increased compared with those who had not taken these drugs in the previous three years, the researchers found. For ibuprofen, the risk increased by almost a quarter (24%) and for diclofenac, it rose by over a half (55%).

The newer generation of anti-inflammatories known as COX-2 inhibitors also were associated with increased rates of first-time heart attack. Those patients who were prescribed the drugs in the preceeding three months were at 21% higher risk of heart attack if taking celecoxib (Celebrex) and 32% increased risk if taking rofecoxib (Vioxx).

'Considerable Implications for Public Health'

Since this study was concluded, rofecoxib was withdrawn due to concerns over heart-attack risk. That makes the impact of this study on patients even more important, say the authors, since those previously taking rofecoxib will have turned to the other anti-inflammatories in greater numbers.

The most significant findings were for the drugs ibuprofen, diclofenac and rofecoxib, say the authors. In terms of "numbers needed to harm" in the 65 and over age group, for those taking diclofenac, one extra patient for every 521 patients was likely to suffer a first-time heart attack.

For rofecoxib, the figure was one patient for every 695 patients; and for ibuprofen, one patient for every 1,005 patients was at risk.

"Given the high prevalence of the use of these drugs in elderly people and the increased risk of myocardial infarction [heart attack] with age, the relatively large number of patients needed to harm could have considerable implications for public health," say the authors.

The nature of this report, an observational study may make it prone to other explanations for the findings, say the authors. "However, enough concerns exist to warrant a reconsideration of the cardiovascular safety of all NSAIDS," they conclude.


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