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'Heart attack risk' for common painkillers - Dr Alex Sirker, Consultant Cardiologist

May 26, 2017

There has been much media coverage of a recent article in British Medical Journal about the increased risks of heart attack associated with taking so-called NSAIDs (BMJ 2017:357:j1909).
The NSAID group includes widely used drugs, such as ibuprofen and diclofenac, which are taken as painkillers and for treatment of certain inflammatory conditions including arthritis.
It has been known for some years that there is a higher rate of heart attack and stroke seen in patients using these drugs. Some drugs in this group appear to carry a particularly high risk – for example one called rofecoxib was withdrawn by the manufacturer as a result of this problem. Previous studies suggested that another NSAID, naproxen, might carry a lower risk than other drugs in this class but this has not been definitively established.

The recent BMJ study was a so-called meta-analysis, which involves pooling the results of several different studies, to improve the ability to detect trends and patterns. This particular study used patient data obtained from Canada, Finland and the UK.
The study found that there was an increased risk of heart attack seen with the use of all 5 NSAID drugs examined, including naproxen.
The overall increase in heart attack risk was between 20-50% compared to people who were not taking these drugs.
Another finding of interest was that the risk associated with use of these drugs appears very soon after starting – within the first week of use.
The risk appears to be greater when higher doses of the NSAID drugs are used.

In any particular patient, the risk of heart attack with these drugs is likely to be related to their 'baseline' risk for coronary (heart) artery disease – in other words, patients who already have known coronary disease or who have risk factors for it (such as smoking or diabetes) will be at greater risk. This should be borne in mind when making decisions about use of these drugs.

Given the findings of this study, it is recommended that alternatives to NSAIDs be borne in mind – including other types of medication for pain relief, or possibly non-medication based treatments such as physiotherapy. However, in many cases, NSAIDs may continue to be needed and have a valuable role in pain relief. In this setting, taking account of a patient's individual risks (as mentioned above) is important. Furthermore, using the drugs in the lowest dose that proves effective, and for the shortest time possible, should help to reduce risks to the heart.

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