Common painkillers linked to increased risk of heart problems

by Terry A. Rondberg, DC

Posted January 19, 2011

Commonly used painkillers for treating inflammation can greatly increase the risk of heart attack and stroke, according to an analysis of the evidence published on the British Medical Journal’s electronic journal, bmj.com.

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

NSAIDs have been among the most freely prescribed of all pain suppressing medications 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 In 2004, the COX-2 inhibitor rofecoxib was withdrawn from the market after a trial found that the drug increased the risk of cardiovascular disease.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, but little has been done to stem the tide of prescriptions.

The BMJ study, conducted by researchers in Switzerland, involved a comprehensive analysis of all randomized 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.

In 29 trials there were a total of 554 heart attacks; in 26 trials there were 377 strokes, and in 28 trials there were 676 deaths. While the absolute risk of cardiovascular problems among people taking painkillers was low, 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 heart attack, 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.

The researchers concluded: "Although uncertainty remains, little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms. Cardiovascular risk 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.

SOURCES: "Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis" BMJ 2011; 342:c7086 (www.bmj.com/cgi/doi/10.1136/bmj.c7086)

"Cardiovascular safety of NSAIDs" (BMJ 2011; 342:c6618) http://www.bmj.com/cgi/doi/10.1136/bmj.c6618

(Dr. Terry A. Rondberg is founder and CEO of the World Chiropractic Alliance and publisher of The Chiropractic Journal. His reports on other health and wellness news appear on www.TerryARondberg.com and www.TerryRondberg.com.)