Healthy heart It’s a story that’s grabbed the medical headlines repeatedly over the last few years – anti-inflammatory medications increase the risk of heart attack – but the big pharmaceutical companies behind the medications have played down the risks, arguing that more research is needed. Now, new research from Copenhagen University in Hellerup, Denmark, has once again found an associated increased risk of heart prolems with non-steroidal anti-inflammatory drugs (NSAIDs) for heart attack patients.
Researchers looked at data from a nationwide study in Denmark, where 83,697 heart attack patients were assessed over a nine-year period. Nearly half – 42% – had been prescribed at least one NSAID after the attack. These included ibuprofen, diclofenac, rofecoxib, celecoxib and naproxen. The researchers found that use of these NSAIDs was associated with an increase of 45% in death or repeat heart attack within a week of treatment; a 55% increase in risk was seen if the treatment lasted up to three months. Only naproxen was not associated with an increased risk, and of those that did significantly increase risk, diclofenac showed the biggest increase. It is thought that NSAIDs may increase the risk of a repeat heart attack because they can cause blood to clot more easily.
While these results might seem extremely worrying for heart patients who take painkillers to relieve symptoms from other illnesses, such as arthritis, for example, they need to be taken into context.
Firstly, some NSAIDs such as rofecoxib have already been withdrawn from the UK market and others, such as diclofenac, aren’t recommended by the NHS for those with heart problems. The Medicines and Healthcare products Regulatory Agency (MHRA) said, "Patients should not be alarmed about the results from this new study. NSAIDs and the newer COX-2 inhibitors are extremely important medicines to treat arthritis and other painful conditions, and for most patients the risks of side effects are outweighed by the benefits... The risks of heart attacks and strokes with these medicines, in patients with and without existing heart conditions, are already recognised... In the UK, healthcare professionasl have been informed and regularly updated with prescribing advice, designed to minimise the risks."
Secondly, the medications used by the study participants were taken at higher doses than you can buy over-the-counter at the chemist – the NSAIDs were prescribed by doctors – so the same statistics and risks do not apply to painkillers you buy yourself. "Any patients with questions about their current anti-inflammatory treatment should speak to their doctor or nurse at their next routine appointment," said an MHRA spokesperson.
First published May 16, 2011