-- Mary Elizabeth Dallas
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
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 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
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.
The U.S. National Institutes of Health provides more information
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