Common painkillers increase heart risks in healthy people

Healthy adults who reach for common painkillers to ease the twinges of everyday aches and pains could be setting themselves up for a heart attack or stroke, according to recent research covered by Nissa Simon in the AARP Bulletin.

Both long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain  and short-term use in healthy men and women who take those drugs for minor complaints has been linked to an increased risk of heart attack or stroke in those who already had heart disease.

“If you use NSAIDs regularly to control chronic pain, talk with your doctor about reducing your other risks for heart disease with a heart-healthy diet, a good exercise program and possibly statins,” says Dr Richard Stein, a cardiologist at New York University School of Medicine.

The painkillers are widely used to ease the discomfort of everything from arthritis to headaches and muscle strains. Five such drugs were included in the study: ibuprofen, diclofenac, naproxen, celecoxib and rofecoxib (most notably Vioxx, which was taken off the US market in 2004 because of heart risks).

“People should be aware that NSAIDs are not risk-free with respect to the cardiovascular system,” says research fellow, Dr Emil Loldrup Fosbøl, the study’s lead author.

In the United States, naproxen and ibuprofen come in both prescription and over-the-counter versions while diclofenac and celecoxib are prescription only.

The researchers tracked more than one million healthy Danes from 1997 to 2005. Since low-dose ibuprofen is the only NSAID available in Denmark without a prescription, they could track and compare those who took the drugs, most of them daily for about two weeks, with those who did not. Risks from different painkillers varied widely.

Although the percentages of increased risk were large, the actual number of those affected was small. The researchers found:

• ibuprofen: a 29% greater risk of fatal or nonfatal stroke.
• diclofenac: almost double the risk of death from heart disease.
• celecoxib: results were inconclusive.
• naproxen: no greater likelihood of heart-related problems and a slightly lower risk of death, leading the researchers to conclude that naproxen could be a safer alternative to other such painkillers.

If you routinely take one of these painkillers, bring up the question of whether you need to continue and, if so, at what dose.

The study appeared in the June 8 online edition of the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes.