A major study has found that a very common group of medications is more dangerous than previously thought, with increased risk of heart attack in some cases.
NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are often used to treat pain, fever, inflammation, headaches, and arthritis.
The new study, which collated extensive research on the subject, found that this kind of arthritis medicine is especially dangerous for heart patients. A particular area of focus has been on older types of arthritis medicine, which have been used widely but which have not until now been as closely scrutinized as new medication. Some of that new medication have previously been removed from sale.
Project leader Morten Schmidt, MD and PhD from Denmark’s Aarhus University, said: “It’s been well-known for a number of years that newer types of NSAIDs — what are known as COX-2 inhibitors, increase the risk of heart attacks. For this reason, a number of these newer types of NSAIDs have been taken off the market again. We can now see that some of the older NSAID types, particularly Diclofenac, are also associated with an increased risk of heart attack and apparently to the same extent as several of the types that were taken off the market.”
He added: “This is worrying, because these older types of medicine are frequently used throughout the western world and in many countries available without prescription.”
New guidance for doctors
As an indication of the frequency of use, more than 15% of the population in western countries are given a prescription for NSAIDs, and this figure increases with age. Around 60 percent of the adult population in Denmark collects at least one prescription for an NSAID over a ten-year period, and around 40 percent of Danish patients with a history of heart problems are prescribed NSAID, according to previous studies.
The new research, which looked at all available information on the use of NSAIDs in patients with heart disease, was undertaken by 14 European universities and hospitals. It prompted the European Society of Cardiology to produce recommendations for doctors on what to consider before prescribing this type of drug to heart patients.
“When doctors issue prescriptions for NSAIDs, they must in each individual case carry out a thorough assessment of the risk of heart complications and bleeding. NSAIDs should only be sold over the counter when it comes with an adequate warning about the associated cardiovascular risks. In general, NSAIDs are not be used in patients who have or are at high-risk of cardiovascular diseases,” said Christian Torp-Pedersen, another Aalborg University study author and a cardiology professor.
Morten Schmidt added: “Many European countries consume more of these drugs than Denmark. But we can still do better and it’s often the case that paracetamol, physiotherapy, mild opioids or other types of NSAIDs with less risk for the heart would be better for the patients. Of course, the recommendations that have been introduced following our study and its review of the heart-related risks are a big step in the right direction in relation to patient safety.”
In the US, the FDA, which gives examples of NSAIDs that include ibuprofen, naproxen, diclofenac and celecoxib, announced in mid-2015 that:
The U.S. Food and Drug Administration (FDA) is strengthening an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) increase the chance of a heart attack or stroke.
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