Painkillers may raise heart attack risk slightly

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All painkillers of the type known as nonsteroidal anti-inflammatory drugs (NSAIDs) seem to increase the risk of having a heart attack, according to a population-based study conducted in Finland.

The finding applies not only to selective COX-2 inhibitors such as celecoxib but also to non-selective drugs like ibuprofen or naproxen.

“Our results do not support the view that COX-selectivity alone determines the cardiovascular adverse effects of NSAIDs,” lead investigator Dr. Arja Helin-Salmivaara and colleagues note in the European Heart Journal.

Accumulating data on the cardiovascular risks associated with COX-2 inhibitors have called into question the safety of nonselective NSAIDs, they note.

The investigators evaluated data for 33,309 heart attack patients entered into the Finnish Hospital Discharge Register between 2000 and 2003. These subjects were compared with 138,949 matched “control” subjects.

Helin-Salmivaara from the University of Turku, in Helsinki, and colleagues found that current use of any type of NSAID was associated with 40 percent increased risk of having a heart attack.

The risk of having a heart attack tended to decline over time after discontinuation of NSAID use, but this trend reached statistical significance only for nonselective NSAIDs.

Still, “even if the risk increase was modest, any risk of serious adverse events is important at the population level if a drug is not life-saving and is widely used, as is the case with NSAIDs,” the researchers conclude.

In a related editorial, Dr. Deepak L. Bhatt, from Cleveland Clinic Foundation in Ohio, points out that the report by the Finnish team is the largest population-based study of NSAIDs performed to date.

Because other studies have yielded different results, and some researchers have suggested that NSAIDs may actually protect the heart, a large clinical trial is needed. To that end, Bhatt and his associates have launched a forward-looking trial to evaluate the safety of celecoxib, ibuprofen and naproxen among 20,000 patients with arthritis, either with cardiovascular disease or at high risk.

SOURCE: European Heart Journal, July 2006.

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