High Doses of Common Painkillers May Raise Risk for Heart Trouble

Review found chances were greatest in those who took NSAIDs and had a history of cardiovascular disease

By Mary Elizabeth Dallas

Thursday, May 30, 2013

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WEDNESDAY, May 29 (HealthDay News) -- People who take high doses of common painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs) face a greater risk for heart problems, a new analysis shows.
Although NSAIDs are used around the world to help people with inflammatory conditions, such as rheumatoid arthritis, a review of nearly 650 randomized trials found that taking either 2,400 milligrams (mg) of ibuprofen or 150 mg of diclofenac daily increased the risk of heart attacks, strokes and death by about one-third. The findings were published online May 29 in the journal The Lancet.
The study authors said, however, that the increased risk of heart attacks from individual NSAIDs is proportional to a patient's underlying risk for heart attacks. Since people with a history of heart problems or risk factors for heart disease are at greatest risk, they concluded that doctors should weigh that before prescribing a high-dose NSAID regimen for such a patient.
"While NSAIDs increase vascular and gastrointestinal risks to a varying extent, our analyses indicate that the effects of different regimens in particular patients can be predicted, which may help physicians choosing between alternative NSAID regimens to weigh up which type of NSAID is safest in different patients," study author Colin Baigent, from the Clinical Trial Service Unit and Epidemiological Studies Unit at the University of Oxford, in England, said in a journal news release.
One expert agreed with that assessment.
"Considering NSAIDs are some of the most commonly used medications and their increased risk of heart disease, stroke, heart failure and death is significant, this meta-analysis may help doctors in guiding patients [about] which NSAID -- and at what dose -- might be the safest for them," said Dr. Suzanne Steinbaum, a preventive cardiologist at Lenox Hill Hospital in New York City.
"Through this analysis, the size of the risk could be predicted for each patient, and better advice could be given," Steinbaum said. "Because NSAIDs sometimes are a crucial part of one's quality of life, the more we understand about dosing, duration and risk becomes important so we [can] determine which is the best choice, -- especially for patients with heart disease or those who are at risk."
This latest review, which examined the outcomes of more than 353,000 patients, found that for every 1,000 patients with a moderate risk for heart disease, three would have an avoidable heart attack after taking high doses of NSAIDs for one year. The researchers said one of these heart attacks would be fatal.
The review also revealed that NSAIDs double the risk for heart failure. People on high doses of NSAIDs also have a two to four times greater risk for bleeding ulcers or other significant upper gastrointestinal problems.
In a commentary published in The Lancet, Dr. Marie Griffin, of Vanderbilt University Medical Center, said: "The meta-analysis offers considerable certainty about ... major vascular risks of high doses of the most commonly prescribed NSAIDs, but leaves large gaps about risks associated with lower NSAID doses, longer durations of use and residual effects after stopping treatment."
Although the analysis uncovered an association between high doses of NSAIDs and an increased risk for heart troubles, it didn't necessarily prove a cause-and-effect relationship.

SOURCE: Suzanne Steinbaum, M.D., preventive cardiologist, Lenox Hill Hospital, New York City; The Lancet, news release, May 29, 2013.

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