Painkillers linked to risk of heart attack, study says

Painkillers linked to risk of heart attack, study says

Painkillers linked to risk of heart attack, study says : (CNN) – Taking even over-the-counter doses of common painkillers known as NSAIDs, nonsteroidal anti-inflammatory drugs, has been linked to an increased risk of heart attack in a new study.

The likelihood of experiencing a heart attack was calculated to increase by an average of 20% to 50%, compared with someone not taking the drugs, regardless of the dosage and amount of time the medications are taken.

The findings are observational and based on an association, however, with the drugs not proved to be a direct cause of heart attack.

Painkillers linked to risk of heart attack, study says

This group of drugs includes ibuprofen, diclofenac, celecoxib and naproxen, which are available over the counter or by prescription for higher doses, to relieve pain or fever resulting from a range of causes, including flu, headaches, back pain and menstrual cramps. Their range of uses also means they are often taken as needed, for short periods of time.

The level of risk increased as early as one week into the use of any drug in this category and at any dose, and the risk associated with taking higher doses was greatest within the first month.

Painkillers linked to risk of heart attack, study says

“We found that all common NSAIDs shared a heightened risk of heart attack,” said Dr. Michèle Bally, an epidemiologist at the University of Montreal Hospital Research Center, who led the research. “There is a perception that naproxen has the lowest cardiovascular risk (among the NSAIDs), but that’s not true.”

Researchers’ overall finding was that taking any dosage of these drugs for one week, one month or longer was linked to an increased risk of a heart attack. The risk appeared to decline when these painkillers were no longer taken, with a slight decline one to 30 days after use and a greater decline, falling below 11%, between 30 days and one year after use.

Painkillers linked to risk of heart attack, study says

Based on the paper, published Tuesday in the BMJ, Bally’s team suggests that doctors and patients weigh the potential harms and benefits before relying on the drugs as a treatment option.

“People minimize the risks because drugs are over the counter and they don’t read labels,” Bally said. “Why not consider all treatment options? … Every therapeutic decision is a balance of benefits and risk.”

Building on previous research

Cardiovascular diseases are the No. 1 cause of death globally, according to the World Health Organization, with 80% of all deaths in this category due to heart attacks and strokes. Each year, it’s estimated that 735,000 people in the United States have a heart attack. In the United Kingdom, more than 200,000 hospital visits each year are due to a heart attack.

Previous research has showed that this class of painkillers could increase the risk of having a heart attack, known as myocardial infarction. In 2015, the US Food and Drug Administration called on drugmakers to update their warnings labels to identify an increased risk of a heart attack or stroke.

Painkillers linked to risk of heart attack, study says

But the specifics in terms of timing, dosage and treatment durations were less clear.

Bally and her team reviewed all available studies in this area from Canadian and European databases, analyzing the findings from 446,763 people, with 61,460 of them having had a heart attack.

Their goal was to calculate the risk, determinants and time course of heart attacks associated with the use of NSAIDs under typical circumstances.

The team looked at very short-term use and at any dose, said Bally. “In real life, people use drugs at low doses and use them on and off,” she said, adding that this is not reflected in many clinical trials, for example, in which people have often been monitored during prolonged use of these drugs.

Painkillers linked to risk of heart attack, study says

When using them for one week, the greatest risk was associated with rofecoxib. Followed by diclofenac, ibuprofen and then celecoxib, respectively, though all except celecoxib had similar levels of risk. Hovering around 50% increased odds of a heart attack, at any dose.

At higher doses, typically needing a prescription. Some drugs had an even greater risk of heart attack between one week and one month of use.

For example, naproxen showed a 75% increased likelihood of a heart attack within one month. With doses of 1200 milligrams per day or more. Naproxen showed an 83% increased likelihood of a heart attack. With doses greater than 750 milligrams per day when taken for one week to one month.

Painkillers linked to risk of heart attack, study says

But the level of risk declined, on average, when the drugs were used for longer than one month.

“This is relative to not taking these drugs, your baseline risk,” Bally said. “The risk is not 75%. It’s an increase (maybe) from a tiny baseline risk that they have.”

Millions of these pills are sold every year, Bally said. “Therefore the risk, no matter how small or relative, is important to note from a population viewpoint.”

Painkillers linked to risk of heart attack, study says

“We already know that these drugs increase your risk of having a heart attack,” said Dr. Mike Knapton, associate medical director at the British Heart Foundation, in a statement.

Knapton further added that people must be made aware of the risk. That alternative medication or treatment should be considered where appropriate. For example, physical therapy or yoga could be used to alleviate pain from an injury.

Association, not causation

The researchers stress that the findings are purely observational, as they used readily available data about certain populations. Not all potentially influential factors could be taken into account, they say.

Stephen Evans, professor of pharmacoepidemiology at the London School of Hygiene & Tropical Medicine, commented that a number of lifestyle factors, such as smoking and body mass index, are not available in the data about the study participants. “It leads to uncertainty,” he said.

Tobacco use, unhealthy diet, obesity, alcohol abuse and hypertension are just a few of many factors. That can cause a heart attack.

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