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'Heart attack risk' for common painkillers

Published 22 May 2017

'Heart attack risk' for common painkillers

A fresh study suggests there may be a link between taking high doses of common anti-inflammatory painkillers - such as ibuprofen - and heart attacks.

The paper, published in The BMJ, builds on a previous body of work linking these drugs to heart problems.

This research suggests the risk could be greatest in the first 30 days of taking the drugs. But scientists say the findings are not clear cut. They say other factors - not just the pills - could be involved.

In the study an international team of scientists analysed data from 446,763 people to try to understand when heart problems might arise.

They focused on people prescribed non-steroidal anti-inflammatory drugs (such as ibuprofen, diclofenac, celecoxib and naproxen) by doctors rather than those who bought the painkillers over the counter.

'Raise awareness'

Studying the data from Canada, Finland and the UK, researchers suggest taking these Nsaid painkillers to treat pain and inflammation could raise the risk of heart attacks even in the first week of use. And the risk was seen especially in the first month when people were taking high doses (for example more than 1200mg of ibuprofen a day) .

But scientists say there are a number of factors that make it difficult to be absolutely certain of the link.

Are the painkillers definitely to blame?

Kevin McConway, emeritus professor of statistics at The Open University, said the paper threw some light on possible relationships between Nsaid painkillers and heart attacks.

But he added: "Despite the large number of patients involved, some aspects do still remain pretty unclear. It remains possible that the painkillers aren't actually the cause of the extra heart attacks."

He said if, for example, someone was prescribed a high dose of a painkiller because of severe pain, and then had a heart attack in the following week, it would be "pretty hard" to tell whether the heart attack had been caused by the painkiller or by whatever was the reason for prescribing it in the first place. It could even be down to something else entirely, he said.

Prof McConway also pointed out that other influences on heart health - such as smoking and obesity - could not be taken into account fully and could be partly to blame.

What should patients do?

Doctors are already aware from previous studies that non-steroidal anti-inflammatory drugs could increase the risk of heart problems and strokes.

And current UK guidelines state that Nsaids must be used carefully in people with heart problems and in some cases (such as very severe heart failure) they should not be used at all.

Dr Mike Knapton of the British Heart Foundation, suggests patients and doctors weigh up the risks and benefits of taking high doses of these common painkillers, particularly if they have survived a heart attack or are at higher risk.

Meanwhile, GP leader Prof Helen Stokes-Lampard said it was important that any decision to prescribe was based on a patient's individual circumstances and medical history, and was regularly reviewed. She said that as new research was published, it was important that it was taken on board to help inform guidelines.

But she added: "The use of Nsaids in general practice to treat patients with chronic pain is reducing, and some of the drugs in this study are no longer routinely prescribed in the UK, such as coxibs, as we know that long-term use can lead to serious side-effects for some patients."

What about over-the-counter use?

This paper looks at patients prescribed painkillers rather than people buying them in a shop or taking them without medical advice. And it suggests higher doses than those often recommended for one-off use (for example more than 1200mg of ibuprofen a day) carry some of the greatest risks.

But Prof Helen Stokes-Lampard said the study should also raise awareness among patients who self-medicated with Nsaids to treat their pain.

According to NHS advice, people should generally take the lowest dose of Nsaids for the shortest time possible.

And if people find they need to take Nsaids very often or are taking higher doses than recommended, medical advice should be sought.

How big are the risks?

Independent researchers say one of the main pitfalls of the study is it does not clearly spell out what the absolute risk - or the baseline risk of people having a heart attacks - is.

And they say without an understanding of the baseline, it is then hard to judge the impact of any possible increase in risk.

Meanwhile, Prof Stephen Evans, of the London School of Hygiene and Tropical Medicine, said though the study indicated that even a few days' use was associated with an increased risk, it might not be as clear as the authors suggested.

He added: "The two main issues are that the risks are relatively small, and for most people who are not at high risk of a heart attack, these findings have minimal implications."

BBC Health News

10 comments


N.wilde
on 19/07/2017

I was taking various diclofenic, naproxen etc for 15 yrs ,last year I had a massive attack & had to have 2  lots of Heart surgery , now I'm left with no anti inflammatorys & heart failure!! This advice should be made much more available ,, I was told it was due to my taking these drugs! I don't smoke or drink & im not oversized ?


avatar
Unregistered member
on 20/07/2017

The more I read about these meds, the more I realise that I did the right thing in giving them up!  It is now about 4 months since I took any prescribed medication and 8 since I took naproxen. I have a mildish form of RA, I think and I am taking capsules of 95% turmeric with 5% black pepper  - easily available on line. It's not perfect, but it gave me my life back! There are no side effects and no risks that I know of.

My rheumatologist is very forward thinking and gave me a list of other food supplements I could try!  I'm set to see her again in about 3 months and I am looking forward to seeing her and telling her how well I'm doing.


Tazzbar
on 22/07/2017

I have been on etoricoxib for over a year and they kept my hands working And free from pain most of the day. Now a new rheumatologist has said I can't have them and wants to put me on antidepressants which also give pain relief. I did not want these as they make me drowsy and I drive . So my Dr put me on codydomol made me vary I'll as I am allergic to codeine . Then he put me on pain patches dreadful reactions , I never had reaction  or side effects to etoricoxib so why mess me about . How do I get a prescription to allow me to have etoricoxib. My previous rheumatologist said it was the best tablet I could be on. Unfortunately I have moved to South Wales hence the change of medical care. I am whar is known as drug allergic 


avatar
Unregistered member
on 26/07/2017

Sbiox1 is absolutely right. For those who wants to stick to paracetamol only, please remember that Paracetamol do cause Liver damage. It stays in your system for a long time, and over a period of time it causes severe Liver damage. It you are taking Paracetamol regularly, rather than as and when required, should request their GP to have blood test done for Paracetamol levels and Liver Function test. They should only be taken when the pain is intense. Like Sbiox, I have also stopped taking Celecoxib since 2015. I was on them for many years. When the Media report came out that patients are having heart attacks on this medication, I stopped them instantly, and started taking Turmeric Milk or Golden Paste which is Turmeric, black pepper, a pinch of cinnamon and ginger and a tea spoon of Olive oil in warm Almond or cashew nut milk along with Fish oils, Glucosamine sulphate, MSM which is a perfect partner of Gluosamine, over 50s Multivitamins and several other supplements. I suffer a lot less pain now, and if I don't take Turmeric milk for a few days, my pain returns, which proves that Turmeric definately helps with pain. Of course being positive, exercises and swimming all helps a great deal too. I hope this helps. Good luck every one who is trying to get off NSAIDs. 


avatar
Unregistered member
on 27/07/2017

Glad to hear that I am not the only one to make the break! I was so unhappy with all the medication - which included prednisolone, omeprazole, and hydroxychloroquine. I also tried various other "heavies" and after the failure of methotrexate  - none of which worked. Turmeric DOES work.

I still have stiffness and swelling, plus occasional pain, but nothing is ever as bad as the terrible pain when I was first diagnosed.  All is now within my bounds of tolerance, especially when I take paracetamol as and when required. I can need a very normal life, as long as I don't try to push myself too far.

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