May 9th, 2011
05:50 PM ET
When heart attack survivors or those with heart disease take certain pain relievers it puts them at higher risk for heart attack or death according to a new study in Circulation, a journal of the American Heart Association. The new research says that even short-term use of NSAIDs, or nonsteroidal anti-inflammatory drugs, is unsafe.
NSAIDs such as ibuprofen, naproxen, Voltaren, Celebrex and others provide relief for those who suffer from painful arthritis, lupus or other debilitating conditions. But when these patients also have heart trouble, the drugs' use is cause for concern.
In 2007, the American Heart Association, recognizing the dangers for this population, released an advisory statement recommending that doctors prescribe these drugs at the lowest dose for the shortest period of time. But the new study out of Denmark says using NSAIDs even at those levels may be putting people at risk.
"Our results indicate that there is no apparent safe therapeutic window for NSAIDs in patients with prior heart attack," explains Anne-Marie Schjerning Olsen, lead author of the study and research fellow at Copenhagen University in Hellerup, Denmark.
From 1997 to 2006, Olsen and others followed more than 83,000 first-time heart attack patients, of which 42% took some type of NSAID. The researchers found that the use of these drugs was associated with a 45% increased risk of death and recurrent heart attack within as little as one week of treatment and a 55% increased risk if the drugs were taken for three months.
Harvard cardiologist Elliott Antman M.D., lead author of the 2007 American Heart Association NSAIDs advisory, was impressed with the study.
"The authors further confirm our prior practical advice that NSAID use should be avoided [in those with heart disease] and if unavoidable should be used at the smallest doses for the shortest time possible," says Antman.
One of the medicines in the study, Vioxx, was removed from the market in the United States because of increased risk of heart attack and stroke. The Food and Drug Administration also has issued warnings or expressed concerns about the health effects of other NSAIDs such as Celebrex and Bextra.
The Consumer Health Care Products Association, the not-for-profit association representing the makers of over-the-counter medicines such as ibuprofen, released this statement about the research.
"As the authors concede, these results do not apply to the low doses used in over-the-counter medicines."
But Antman says that pain relievers such as ibuprofen and other NSAIDs available without a prescription also need to be monitored.
"I think this study is significant because these drugs are taken very commonly, many are available over the counter. Many patients assume that if you can get a drug OTC as opposed to requiring a prescription for it, it must be safer and that is just not the case," explains Antman.
Novartis, the maker of the drug diclofenac, marketed as Voltaren, said diclofenac was "well-tolerated and effective when used as directed," and noted that all NSAIDs should be used at the lowest effective dose for the least possible time.
Pfizer, the maker of Advil and Celebrex, said the new findings didn't change its understanding of the benefits and risks of the drug. "This retrospective observational analysis has a number of limitations that are acknowledged in the manuscript," Pfizer added. "As the authors themselves noted, further studies and preferably randomized clinical trials are warranted to establish the cardiovascular profile of NSAIDs."
Further, the company said, "Patients should speak with their health care professional to determine the right treatment for them individually.”
Antman says NSAIDs may increase heart attack risks because they can cause the blood to clot more easily, which can lead to blockages. If these blockages lodge in the arteries that feed the heart this may bring on a heart attack.
So what do you take if you are a heart patient in pain and you need relief? According to Antman, this study leads him to conclude that in that specific case, "Tylenol and naproxen in that order are the safest drugs." But he adds, as always, check with your doctor to see what is the safest and most effective treatment for you.
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