Serious heart palpitations prompted by new study on NSAIDs

A study reported in BMJ (formerly the British Medical Journal) revealed potentially significant health news regarding non-steroidal anti-inflammatory drugs (NSAIDs), pain-relievers which are among the most commonly used over-the-counter medicines. A meta-analysis by Swiss researchers of 31 separate studies covering more than 100,000 patients has concluded that taking NSAIDs can more than double the risk of heart attack and stroke. The researchers emphasized that the absolute chance of a heart attack or stroke caused by the drugs is low. However, the size of the study and the extent to which the probabilities of heart attack or stroke are elevated by the medications concerns ACSH’s Dr. Gilbert Ross.

The seven NSAID drugs examined by the researchers included such everyday medications as ibuprofen (Advil) and naproxen (Aleve). The other five medicines considered were diclofenac, celecoxib (Celebrex), etoricoxib, rofecoxib (Vioxx) and lumiracoxib. While several are off the market or rarely used, Celebrex, Aleve and ibuprofen are very widely used, especially for control of pain and inflammation caused by arthritis.

Dr. Ross says that, “These drugs may be reasonably safe to prescribe to non-smoking patients under the age of 65 without a heart problem for a short period of time. But when physicians contemplate recommending them to patients with risk factors for cardiovascular disease, consideration must be given to the risk-benefit equation, which is now altered by these data.”

He asks, “What are the alternatives? Narcotics like codeine and percocet are addictive and have unpleasant side effects. Aspirin may be good for the heart, but it can cause gastrointestinal bleeding. Acetaminophen (Tylenol) in excess can be toxic to the liver. Any benefits derived from pain-killers come with a risk profile. I think a doctor treating a 70-year old patient who smokes and wants NSAIDs may wish to inform him of the risks. Chronic pain is a serious problem, and there are no easy answers.”

ACSH’s Dr. Elizabeth Whelan adds: “This is an unwelcome reminder that all drugs present a mix of costs and benefits.”