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Painkiller use linked to cardiac risk

Doctors advised to assess risk when prescribing anti-inflammatory drugs

Jo Carlowe

Wednesday, 12 January 2011

Commonly used painkillers for treating inflammation can increase the risk of heart attacks and strokes, according to new review.

The findings printed on BMJ.com today, list traditional non-steroidal anti-inflammatory drugs (NSAIDS) as well as new generation anti-inflammatory drugs, known as COX-2 inhibitors, among the drugs involved.

The researchers say that doctors and patients need to be aware that prescription of any anti-inflammatory drug needs to take cardiovascular risk into account.

The authors of this Swiss study performed a comprehensive analysis of all randomised 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.

Overall, the number of harmful outcomes that could be compared for placebo versus treatment was low. In 29 trials there was a total of 554 heart attacks; in 26 trials there were 377 strokes, and in 28 trials there were 676 deaths. So the absolute risk of cardiovascular problems among people taking painkillers was low, but 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.

Naproxen appeared least harmful in terms of cardiovascular safety among the seven analysed preparations.

“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,” the authors concluded.

An accompanying editorial noted that many patients have both cardiovascular disease and musculoskeletal disease, and suggested that it is time for an evaluation of a broader range of alternatives.

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