Painkillers may raise heart attack risk

August 2, 2006

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NEW YORK (Reuters Health) - 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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