Painkillers Can Increase the Risk of Heart Attacks and Strokes

According to researchers, patients and doctors need to be more aware of the cardiovascular risk when prescribing any anti-inflammatory drug, which includes the new generation anti-inflammatories called COX-2 inhibitors as well as traditional NSAIDS (non-steroidal anti-inflammatory drugs).

NSAIDs have been widely used for pain management in osteoarthritis patients and those with other painful disorders. The COX-2 inhibitor known as rofecoxib was removed from the market in 2004 after a study revealed that cardiovascular disease risk was increased by the drug. There has since then been a great deal of discussion concerning the cardiovascular risks of traditional NSAIDs as well as COX-2 inhibitors, without resolution from several studies.

The researchers conducted a comprehensive analysis of 31 randomised controlled studies and 116,429 individuals using 7 different drugs (ibuprofen, naproxen, diclofenac, etoricoxib, celecoxib, lumiracoxib, rofecoxib) or placebo to give a more accurate picture of the cardiovascular safety of these drugs compared to previous research.

Generally speaking, the amount of harmful outcomes for treatment compared to placebo was low. There were 377 strokes in 26 studies, there were 554 heart attacks in 29 studies, and there were 676 deaths in 28 studies. This means that the overall risk of cardiovascular issues in individuals using painkillers was low. The researchers did however find that important risks were linked to the drugs.

For example, lumiracoxib and rofecoxib were linked to double the risk of heart attack in comparison to placebo, and ibuprofen was linked to over 3 times the risk of stroke. Diclofenac and etoricoxib were linked to the about 4 times the risk of cardiovascular death.

With regard to cardiovascular safety, naproxen seemed to be the least harmful among the 7 analysed preparations.

Despite the fact that the amount of cardiovascular events in the studies was low, this study does provide evidence on the risks of this type of drug. And even though there is still uncertainty, little evidence is available to indicate that any of the researched drugs are safe in terms of cardiovascular risk, which needs to be considered with the prescription of any NSAID.

The Painful Truth Behind Painkillers Infographic

The Painful Truth Behind Painkillers Infographic

References: DOI: 10.1136/bmj.c7086