January 11th, 2011
06:31 PM ET
Now there's even more reason to talk to your doctor about what kinds of painkillers you're taking.
Supporting previous research on the subject, a large meta-analysis of 31 studies has found significant risks of cardiovascular events in people who take prescription-strength nonsteroidal anti-inflammatory drugs (NSAIDs).
This research, published in the British Journal of Medicine, used a more sophisticated technique than previous studies, said Wayne Ray, professor and director of the Department of Preventive Medicine at Vanderbilt University and author of an editorial that accompanied the study.
The analysis spanned studies including a total of more than 116,000 patients. Scientists looked at trials that had compared NSAIDs with other NSAIDs or placebo.
Of the drugs studied, they found that ibuprofen (sold as Advil and others) carries the highest risk of stroke, etoricoxib (Arcoxia outside the United States; not sold in the U.S.) has the highest risk of cardiovascular death, and rofecoxib (previously sold as Vioxx in the United States, but it has since been withdrawn) carries the highest risk of heart attack.
For certain drugs such as celecoxib (sold as Pfizer's Celebrex), the cardiovascular risk appears to go up with dosage.
But the study did not consider the bleeding problems that can accompany usage of NSAIDs, said Dr. Jeffrey Berger, assistant professor of medicine at NYU Langone Medical Center in New York. This is an important limitation.
Also, the study did not look specifically at patients who were at risk for cardiovascular problems already; although these people should be particularly wary of NSAIDs. That means that this data probably underestimated the risks of these drugs, Berger said.
He also questions how much weight to put on the ibuprofen and stroke finding, because only two of the 31 trials looked at that question.
Even though research has focused on prescription-strength doses of these drugs, the risks most likely apply to what's sold over the counter, especially given that a person can ingest the equivalent of a prescription dose by taking enough pills bought over the counter, Berger said.
Of the NSAIDs examined across these trials, naproxen, the key ingredient in Aleve and other medications, is the safest, the study found. This drug still carries cardiovascular risk, but perhaps not as much as others such as ibuprofen, experts said.
It seems that all of the NSAIDs seem to either prevent or raise the risk of cardiovascular events, and one theory is that naproxen has the best balance between the two, Ray said. Still, there is much more to be learned about naproxen; there has not been a large-scale clinical trial comparing it against a placebo for cardiovascular effects.
A major study that could change current recommendations is called PRECISION, which compares celecoxib to prescription-strength doses of ibuprofen and naproxen in terms of cardiovascular risk. Participants are patients with arthritis who are at risk for cardiovascular problems, or who have had a history of them. The study began in 2006 and is scheduled to end in 2014.
Bottom line: Talk to your doctor to assess the risks and benefits before you take NSAIDs, and make sure you disclose any heart risks you may already have.
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