Common pain relievers raise heart risk for healthy folks

Common Pain Relievers Raise Heart Risk for Healthy Folks
Safety of drugs like Advil and Aleve differ, study finds
By Ed Edelson

HealthDay Reporter
TUESDAY, June 8 (HealthDay News) -- Healthy people who take nonsteroidal
anti-inflammatory drugs to relieve minor aches and pains may raise their risk of
dying from heart-related problems, a Danish study finds.
The American Heart Association and the U.S. Food and Drug Administration
already warn people with heart disease to be cautious about taking NSAIDs,
which include ibuprofen (brand named Advil, Motrin) and diclofenac.
The new study is the first to show the same kind of increased risk among people
without cardiac problems, says a report in the July issue of Circulation:
Cardiovascular Quality and Outcomes
, published online June 8.
"Very few studies have been designed to answer the important question: Do
NSAIDs also increase the cardiovascular risk among healthy people who use
these drugs for minor complaints?" said lead author Dr. Emil L. Fosbol, a
cardiologist at Gentofte University Hospital in Hellerup. "This study is the first to
confirm that the cardiovascular risk is indeed increased when healthy individuals
use some of the drugs."
The risks for different NSAIDs -- found in an analysis of national medical records
of more than one million Danes from 1997 to 2005 -- varied widely. Participants,
whose average age was 39, who used ibuprofen had a 29 percent greater risk of
fatal or nonfatal stroke, compared to those who took no NSAID.
Use of diclofenac (Voltaren and Cataflam) was associated with a 91 percent
higher risk of death from all cardiovascular diseases, while rofecoxib (Vioxx) use
was associated with a 66 percent increased risk. But the study found no
increased risk of cardiovascular problems -- indeed, a slightly lower risk of death
-- associated with naproxen, sold over the counter with brand names including
For people taking the largest doses, diclofenac was associated with a doubled
risk of heart attack, and rofecoxib (Vioxx) was associated with a threefold
increased risk of heart attack. Vioxx was taken off the U.S. market in 2004
because of a study finding high rates of heart attack and stroke.
"These findings are completely consistent with what we have found in patients
with cardiovascular disease," Dr. Michael E. Farkouh, a clinical cardiologist at
Mount Sinai Cardiovascular Institute in New York City, said of the Danish study.
"Drugs that elevate blood pressure and are associated with a thrombotic [artery-
blocking] effect can be harmful in patients who are otherwise healthy."

The percentage increases in the study were large, but the absolute overall risk in
otherwise healthy people was small, Farkouh said. Nevertheless, "before you
take any medication, you should consult with a physician, particularly these
medications," he said.
That warning applies especially to people who exercise regularly and are thus
more likely to take an NSAID for muscle and joint pain, Farkouh said. Regular
use of an NSAID increases the risk not only of cardiovascular problems but also
of bleeding, a known side effect of the medications, he said.
In fact, the Danish study found an increased incidence of major bleeding events,
some fatal, from all NSAIDs except celecoxib (Celebrex). Celecoxib did not
appear to raise the risk of coronary death or stroke either.
The Danish findings are consistent with a 2007 American Heart Association
(AHA) scientific statement about the increased risk of heart attack and stroke
associated with NSAID use, said Dr. Elliott Antman, professor of medicine at
Harvard Medical School and Brigham and Women's Hospital, lead author of that
paper, in a statement issued Tuesday by the AHA.
"The recommendations we made were based on our best estimates from the
existing pharmacological and biological research available at the time," Antman
said. "I find this new study reassuring because it endorses the recommendations
we made using a large body of actual clinical evidence."
Antman's advice for anyone taking an NSAID regularly is that "it is advisable to
discuss with your physician why it was originally recommended or prescribed,
whether you need to continue taking it, and at what dose."
It may be wise to consider alternatives, the study authors and other experts said.
"The majority of studies have shown that naproxen has a safe cardiovascular risk
profile and that ibuprofen in low doses (1200 mg and below per day) also is safe
in respect to the cardiovacular risk," Fosbol said.

More information

SOURCES: Michael E. Farkouh, M.D., clinical cardiologist, Mount Sinai Medical
Center, New York, N.Y.; Elliott Antman, M.D., professor, medicine, Harvard
Medical School, Brigham and Women's Hospital, Boston; Emil L. Fosbol, M.B.,
Ph.D., cardiologist, Gentofte University Hospital, Hellerup, Denmark; June 8,
2010, Circulation: Cardiovascular Quality and Outcomes, online
. All rights reserved.


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