Over-the-counter painkillers such as ibuprofen can double the risk of a heart attack, researchers warned yesterday.
Up to nine million Britons depend on such drugs to relieve the symptoms of arthritis, headaches and other common ailments.
Now sufferers face the dilemma of whether to continue taking some of the most commonly-used painkillers after they were found to carry similar risks to other drugs which have already been withdrawn.
However doctors quickly moved to reassure patients that the benefits of such drugs to their quality of life far outweigh the risks.
A study published in the British Medical Journal highlighted the problems of two of the most widely used non-steroidal anti-inflammatory drugs (NSAIDs) ibuprofen and diclofenac.
The research by the British Medical Council, which analysed the results of 138 trials involving 140,000 patients, found that high doses of the drugs are to blame for three extra heart attacks a year for every 1,000 people taking them who do not have existing heart disease. This is double the normal risk of heart attack.
Researchers found that high-strength NSAIDs are as risky for the heart as Cox 2 category painkillers, including Vioxx, which was voluntarily taken off the market in September 2004 after a three-year study showed an increased risk of heart attacks and strokes after 18 months or more of use.
Vioxx had previously been used by around 400,000 Britons suffering arthritis and chronic pain, and patients with heart disease or at high risk of a stroke have since been advised not to take other Cox-2 painkillers.
But arthritis specialists and charities last night said many patients depend on “lifesaver” NSAIDs painkillers to relieve pain and for mobility.
Professor Robert Moots, professor of rheumatology at Liverpool University and clinical advisor to Arthritis Research Campaign, said: “These drugs can be a lifeline for patients. No drug can be guaranteed against side effects and the heart risks are fairly modest.
“In clinical trials patients are taking high dose drugs religiously for long periods of time but real life isn’t like that.
“People take them when they need to so the risks are probably lower and when explained to patients many want to continue using painkillers rather than have no quality of life.”
‘Safe for short-term use’
Dr Madeleine Devey, scientific adviser to Arthritis Care, said: “These are fairly safe drugs, especially for short-term use, but patients should be encouraged to re-think pain control and try other medication where they can.”
The researchers, based at the University of Oxford and the University of Rome, found that ibuprofen and diclofenac could cause heart attacks when taken in high doses. As expected, Cox 2s also doubled the risk of an attack.
When all ‘vascular events’ – heart attacks, stroke, or vascular disease were taken together, the risks increased by 40 per cent for people on the drugs.
The risks linked to high-dose naproxen, another NSAID, were lower.
Dr Colin Baigent, who directed the research for the MRC, said arthritis patients should not panic over the findings – which relate to the highest doses recommended by doctors and twice what people would take normally.
He said: “People who are popping these for the odd headache, the risks to them are minimal.
“They do carry heart risks for people taking high doses regularly, although they are modest for those without heart disease, and we should not forget they can cause gastrointestinal bleeding.”
Professor Peter Weissberg, Medical Director of the British Heart Foundation said: “This study adds to the mounting body of evidence that taking high doses of NSAIDS increases the chances of having a heart attack.
“However, the increased risk is small and many patients with chronic debilitating pain may well feel that this small risk is worth taking to relieve their symptoms.”
Research last month suggested ibuprofen-type painkillers increase the risk by one-third of people being admitted to hospital with heart failure.
Ibuprofen is one of the most popular over-the-counter painkillers available from pharmacists and supermarkets with 46 tons sold here each year.
The International Ibuprofen Foundation said: “Importantly it should be emphasised that the study specifically referred to high dose prescription treatment of patients with painful conditions, particularly osteoarthritis.
“The occasional and short-term use of ibuprofen for minor pain conditions i.e. the way the majority of consumers in the UK use over the counter ibuprofen products, is not shown to be a risk factor.”