Regular use of common painkillers increases risk of heart attack, study reports

A study published in the British Medical Journal suggests that when people use commonly prescribed non-steroidal anti-inflammatory drugs (NSAIDs) for treating pain and inflammation, the risk of heart attack increases as early as in the first week of consumption and particularly within the first month of using such medication in high doses.

Physicians and patients urged to consider the risks and benefits of drugs such as ibuprofen, diclofenac, celecoxib, and naproxen.

Prior studies recommended that the risk of heart attack (acute myocardial infarction) may increase when using traditional and COX 2 selective NSAIDs; however, the particular time of the risk, consequence of the dose, duration of the treatment, and the comparative risks between NSAIDS were not understood well.

The study led by Michèle Bally of the University of Montreal Hospital Research Center (CRCHUM), then an epidemiology doctoral student at McGill University in Canada, described the heart attack risks related to the consumption of oral NSAIDs under real-life practice conditions.

For the study, the international team of researchers carried out a methodical review and a meta-analysis of applicable studies from a variety of healthcare databases, including those from Canada, Finland, and the United Kingdom. Collectively, they investigated the outcome on over 400,000 individuals and found that more than 60,000 had suffered a heart attack.

The three main traditional NSAIDs, diclofenac, ibuprofen, and naproxen, and COX-2 selective inhibitors - celecoxib and rofecoxib, are of interest to researchers, and to provide guidance, they presented their findings as the likelihood of having a heart attack. The researchers looked at a variety of scenarios subsequent to how people may regularly use these drugs.

The study findings revealed that the consumption of any dose of NSAIDs for a week, a month, or more than a month is connected with increased heart attack risk.  The risk of heart attack associated with Naproxen is the same as that of the risk documented for other NSAIDs. Celecoxib showed a lower risk when compared with rofecoxib; however, the risk levels were the same when compared with that of traditional NSAIDs.

Using NSAIDs increases the overall heart attack risk by about 20–50%, compared with the non-consumption of these drugs. In this view, as a result of this increase, heart attack risk attributed to NSAIDs is about 1% annually on average. The study type was observational and it allowed the researchers to conclude that all NSAIDs studied are connected to a maximum of heart attack risk, the probability being greater than 90%.

On further analysis, the study recommended that heart attack risk connected with consumption of NSAIDs was highest with the consumption of higher doses during the first month. Researchers cautioned that even though the results did not show that the risk continued when the treatment duration was extended, and so it is suggested to use NSAIDs for a short time period as much as possible, as repeat heart attacks was not covered in the study.

The authors said that even though the cause and effect could not be concluded, as the study was based on drug prescribing or dispensing meaning not all potentially influential factors were considered, the study was the largest investigation of its type and its real-world origin helped to make certain that the findings were broadly generalized.

To make healthcare decisions that may improve care offered to patients, the researchers emphasized the advantages of sharing de-identified patient data. They concluded that before instituting treatment, prescribers should think about weighing the risks and the benefits of NSAIDs, higher doses in particular as the onset of acute myocardial infarction risk occurs in the first week and the danger appears to be the greatest in the first month of treatment with higher doses.

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