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New Study Shows Link Between Prescription NSAIDs and Heart Failure

Oct 3, 2016

A new study reveals that the use of prescription-strength pain relievers such as ibuprofen, and naproxen could be linked to a higher risk of heart failure.

Medicines like these, known as non-steroidal anti-inflammatory drugs (NSAIDs), may raise a person's relative risk of heart failure by nearly 20 percent, Health Day reports. That risk increases with the amount of NSAIDs a person is taking, said study author Andrea Arfe, a Ph.D. student at University of Milano-Bicocca, in Italy.

A person's risk of hospitalization for heart failure doubles with some NSAIDs used at very high doses. The researchers analyzed medical records for nearly 10 million patients. Arfe said the findings, “which focused only on prescription NSAIDs-might apply to over-the-counter NSAIDs as well," according to Health Day. Over-the-counter NSAIDs are typically used at lower doses and for a shorter time, but they are sometimes available at the same doses as prescription NSAIDs and they may be “inappropriately overused,” according to Arfe. The study findings were published on September 28 in the BMJ.

The American Academy of Orthopaedic Surgeons (AAOS) explains that NSAIDs decrease inflammation and pain by blocking an enzyme called cyclooxygenase, which comes in two forms, COX-1 and COX-2. COX-1 protects the stomach lining from digestive acids. Injured or inflamed joints produce COX-2. Traditional NSAIDs—like aspirin or ibuprofen—block the action of both COX-1 and COX-2 and this is why some people suffer from stomach upset after taking an NSAID. Newer NSAIDs like Celebrex (celecoxib) target only COX-2, and are referred to as COX-2 inhibitors.

Dr. Christopher O'Connor, editor-in-chief of the cardiology journal JACC: Heart Failure, said NSAIDs might play a role in heart failure, because they cause people to retain sodium. While NSAIDs play an important role in pain relief and have anti-inflammatory properties, they have been show to hold onto sodium and people taking them experience “some reduction in kidney function."

Arfe and colleagues examined millions of European health records from 1999 through 2010. The patients came from Germany, Italy, the Netherlands and the United Kingdom. The analysis included 27 individual NSAIDs: 23 traditional NSAIDs and four selective COX-2 inhibitors. The researchers identified more than 92,000 hospital admissions for heart failure, and matched those patients against 8.2 million patients without such histories.

The researchers concluded that people who had been prescribed an NSAID within the previous two weeks had a 19 percent increased risk of hospital admission for heart failure. Arfe said they researchers saw evidence that heart failure varied according to the type of the NSAID used, Health Day reports.

The traditional NSAIDs associated with increased risk of heart failure are diclofenac, ibuprofen (Motrin), indomethacin, ketorolac (Toradol), naproxen (Aleve or Midol), nimesulide, and piroxicam. The COX-2 inhibitors that increased heart-failure risk are etoricoxib and rofecoxib. Neither of these is approved for used in the United States. The COX-2 inhibitor celecoxib (Celebrex) did not increase risk of heart failure at commonly used doses, which provides patients a safe alternative, Arfe said.

Dr. O'Connor recommends that anyone regularly taking an NSAID should speak with their doctor potential heart risk, rather than stopping the medication without consultation. O’Connor emphasized that the study reports a relative increase in risk. This means that people with good heart health face little added danger from NSAIDs. An increase from, say, 1 percent to 1.2 percent is probably acceptable. But a jump from 20 percent to 30 percent is cause for concern.

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