May 11, 2011
Short-Term Pain Killers Could Put Heart Patients at Risk
(Ivanhoe Newswire) -- Even short-term use of some painkillers could be dangerous for people who've had a heart attack.
Researchers analyzed the duration of prescription non-steroidal anti-inflammatory drugs (NSAIDs) treatment and cardiovascular risk in a nationwide Danish cohort of patients with prior heart attack. They found the use of NSAIDs was associated with a 45 percent increased risk of death or recurrent heart attack within as little as one week of treatment, and a 55 percent increased risk if treatment extended to three months.In a 2007 statement, the American Heart Association advised physicians about the risks of NSAID use among heart patients and provided a stepped care approach.
In the current study, researchers undertook the first time-to-event analysis of a nationwide group and investigated if the duration of prescription NSAID treatment influenced the cardiovascular risk among heart patients. Among 83,697 heart attack survivors (average age 68; 63 percent men), 42.3 percent had a least one prescription for an NSAID.
The most common NSAIDs prescribed were ibuprofen (23 percent) and diclofenac (13.4 percent). Selective COX-2 inhibitors "” rofecoxib (4.7 percent) and celecoxib (4.8 percent) "” were also used.
All NSAIDs were associated with an increased risk of death or recurrent heart attack, with diclofenac having the highest risk (nearly three times). "Overall, NSAID treatment was associated with a statistically significant increased risk of death," said Anne-Marie Schjerning Olsen, M.B., lead author of the study and research fellow at Copenhagen University in Hellerup, Denmark. "Our results indicate that there is no apparent safe therapeutic window for NSAIDs in patients with prior heart attack."
The NSAID naproxen was not associated with an increased risk of death or recurrent heart attack. However, previous studies found increased gastrointestinal bleeding with naproxen.
Olsen said "a very conservative approach to use NSAIDs in patients with prior heart attack is warranted.
"The accumulating evidence suggests that we must limit NSAID use to the absolute minimum in patients with established cardiovascular disease," researchers said. Further study is warranted to establish the cardiovascular safety of NSAIDs, they said.
SOURCE: Journal of the American Heart Association, May 10, 2011