Taking certain painkillers daily for some years carries a small increased risk of heart attack and stroke, research has suggested.
The findings relate to non-steroidal anti-inflammatory drugs like ibuprofen prescribed long-term to treat painful conditions. The report, published in the British Medical Journal, looked at more than 100,000 patients in 31 clinical trials.
A Swiss team analysed data from existing large-scale studies comparing use of non-steroidal anti-inflammatory drugs (NSAIDs) – naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib and lumiracoxib – with other drugs or placebo. One of the drugs – rofecoxib (also known by its brand name, Vioxx) was withdrawn in 2004 when other studies found a raised risk of heart attacks.
Most of the patients were elderly, with conditions like osteoarthritis, and were taking high doses of NSAIDs daily for at least a year. The researchers found the medicine increased the risk of death from stroke or heart attack by between two and four times, compared with placebo.
Peter Juni, professor of clinical epidemiology at the University of Bern, Switzerland, told: “For elderly (people) with musculoskeletal pain there must be extreme care when prescribing or taking these drugs.” But he stressed that the findings did not relate to people taking anti-inflammatories now and again for symptoms such as period pain or sports injuries.
Medical director Professor Peter Weissberg said: “This confirms what has been known for some years now – taking non-steroidal, anti-inflammatory drugs on a regular basis increases heart attack or stroke risk.
“However, some patients with debilitating joint pains may consider the small increased risk worthwhile when set against the improvement in their quality of life that these drugs bring.
Professor Maxwell said: “The advice to the public should continue to be to take this class of drugs only when they are genuinely necessary to control pain and in the lowest effective dose, not only because of any cardiovascular risk but also because of potential effects on the stomach.”
Traditional NSAIDs and the newer COX-2 inhibitors are extremely important medicines to treat arthritis and other painful conditions, and for most patients the risks of side effects are outweighed by the benefits.
COX-2 inhibitors are a new generation of NSAID drugs, which include celecoxib and rofecoxib. Far fewer GPs are now prescribing NSAIDs and COX-2 to their arthritis patients, particularly those with cardio-vascular problems, because of the potential risks, yet for many people who are not at high risk of heart attacks and strokes they remain a highly effective means of combating pain.
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