Common painkillers linked to increased risk of heart problems

January 11, 2011

Commonly used painkillers for treating inflammation can increase the risk of heart attacks and strokes, according to an analysis of the evidence published in the British Medical Journal today.

The drugs include traditional non-steroidal anti-inflammatory drugs (NSAIDS) as well as new generation anti-inflammatory drugs, known as COX-2 inhibitors.

The researchers say that doctors and patients need to be aware that prescription of any anti-inflammatory drug needs to take cardiovascular risk into account.

NSAIDs have been the cornerstone of managing pain in patients with osteoarthritis and other painful conditions. In 2004, the COX-2 inhibitor rofecoxib was withdrawn from the market after a trial found that the drug increased the risk of cardiovascular disease. Since then, there has been much debate about the cardiovascular safety of COX-2 inhibitors and traditional NSAIDs, which several studies have not been able to resolve.

So researchers in Switzerland performed a comprehensive analysis of all randomised controlled trials comparing any NSAID with other NSAIDs or placebo.

They included 31 trials and 116,429 patients taking seven different drugs (naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib, lumiracoxib) or placebo to provide a more reliable estimate of the cardiovascular risks of these drugs than previous studies.

Overall, the number of harmful outcomes that could be compared for placebo versus treatment was low. In 29 trials there was a total of 554 heart attacks; in 26 trials there were 377 strokes, and in 28 trials there were 676 deaths. So the absolute risk of among people taking was low, but the researchers did find that, relative to placebo, the drugs carried important risks.

For instance, compared with placebo, rofecoxib and lumiracoxib were associated with twice the risk of , while ibuprofen was associated with more than three times the risk of stroke. Etoricoxib and diclofenac were associated with the highest (around four times) risk of cardiovascular death.

Naproxen appeared least harmful in terms of cardiovascular safety among the seven analysed preparations.

Although the number of cardiovascular events in the trials was low, the authors say "our study provides the best available evidence on the safety of this class of drugs." They conclude: "Although uncertainty remains, little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms. needs to be taken into account when prescribing any non-steroidal anti-inflammatory drug."

An accompanying editorial says these cardiovascular risks are worrying because many patients have both cardiovascular disease and musculoskeletal disease, and suggests that it is time for an evaluation of a broader range of alternatives.

Explore further: Reducing side-effects of painkillers

Related Stories

Reducing side-effects of painkillers

September 12, 2006

Cardiff University researchers have increased the understanding of why some painkillers increase the risk of heart attack and stroke.

Ibuprofen puts high risk cardiac patients at risk

April 5, 2007

Doctors who treat the painful condition of osteoarthritis in patients with increased cardiovascular risk need to be cautious. A team lead by researchers at Mount Sinai School of Medicine, are the first to study outcomes in ...

New research to reduce drug side-effects

July 9, 2009

They are a group of drugs which millions of people rely on to keep pain at bay but they can have unwanted side-effects which are sometimes more serious than the original health problem. Now scientists at The University of ...

NSAIDs may be more effective than paracetamol for period pain

January 20, 2010

Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may be more effective for relieving period pain than paracetamol, according to the update of a Cochrane Review. However, it remains unclear whether any one NSAID ...

Recommended for you

Machine Translates Thoughts into Speech in Real Time

December 21, 2009

(PhysOrg.com) -- By implanting an electrode into the brain of a person with locked-in syndrome, scientists have demonstrated how to wirelessly transmit neural signals to a speech synthesizer. The "thought-to-speech" process ...

Quantum Theory May Explain Wishful Thinking

April 14, 2009

(PhysOrg.com) -- Humans don’t always make the most rational decisions. As studies have shown, even when logic and reasoning point in one direction, sometimes we chose the opposite route, motivated by personal bias or simply ...

2 comments

Adjust slider to filter visible comments by rank

Display comments: newest first

CarolinaScotsman
5 / 5 (2) Jan 11, 2011
" Cardiovascular risk needs to be taken into account when prescribing any non-steroidal anti-inflammatory drug."

Isn't aspirin a non-steroidal anti-inflammatory drug? Isn't it routinely prescribed to help prevent heart attacks? I suspect much more research needs to be done before one paints the enitre class of NSAIDS with the same brush as the cox-2 inhibitors.
ormondotvos
not rated yet Jan 13, 2011
Scare science.

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.