NSAIDs Painkillers Increase Your Risk Of Heart Attack

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NSAIDs Painkillers Increase heart AttackBad news for all of us who pop painkillers for aches and pains. New Research has shown that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a significantly increased risk of myocardial infarction (heart attack).

What Are NSAIDs?

NSAIDs are are class of drugs which reduce pain, fever and inflammation. They are stronger than acetaminophen (Panadol/ Paracetamol), and work by inhibiting enzymes (COX I and COX II), in turn reducing the bio-chemicals in the body which produce symptoms of pain, inflammation and fever (prostaglandins and thromboxanes).

The most common NSAIDs include:
Aspirin
Mefanemic Acid (Ponston)
Naproxen (Synflex)
Diclofenac Acid (Voltaren)
Ibuprofen (Brufen)

Newer NSAIDS (the COX II inhibitors), which cause less gastric side effects include:
Celecoxib (Celebrex)
Etoricoxib (Arcoxia)
Refecoxib (Vioxx) – discontinued

NSAIDs Side Effects Have Long Been Known

Despite being such a commonly used drug, NSAIDs are notorious for some side effects, the most common being gastric bleeding and ulcers. These can be catastrophic and even cause death. The newer COX II inhibitors have less gastric side effects through selective inhibition of COX II rather than both COX I and COX II.

The other serious side effect associated with with NSAIDs is heart attack and stroke. In 2014, the highly popular Vioxx was voluntarily withdrawn from the market by Merck & Co. after a study showed that patients taking the drug on a long-term basis face twice the risk of a heart attack compared with patients receiving placebo.

Other NSAIDs, aside from Aspirin, are also associated with increased heart attack and stroke risk. Naproxen was thought to be the safest of the lot, until now.

New Study Confirms ALL NSAIDs Increase Heart Attack Risk

A new meta-analysis confirms our worst fears – that NSAIDs indeed increase our risk of heart attack. The increased risk occurred as early as the first week of use and the risk was greater with higher doses.

“Taking any dose of NSAIDs for one week, one month, or more than a month was associated with an increased risk of myocardial infarction. Greater risk of myocardial infarction was documented for higher dose of NSAIDs. With use for longer than one month, risks did not appear to exceed those associated with shorter durations.” – extracted from the paper.

Comparing the different NSAIDs, celecoxib (Celebrex) increased heart attack risk to the same degree as traditional NSAIDs.

Can We Still Take NSAIDs Painkillers Safely?

Arcoxia Dr Siew
Athough there is a definite increase heart attack risk, the chance of a heart attack for most of us taking NSAIDs is still very small. Taking the risk ratios – for every 100 people taking NSAIDs for a year, there will be 1 extra heart attack.
What is worrying about this new research is that we used to think that the increased heart attack risk only occured with long term NSAID usage, however we now know that there is a rapid increase in the first week of usage.
Despite this, NSAIDs have a definite place in medicine. They are indispensable in our daily practice. Some recommendations on the usage of NSAIDS:
1) Think twice before you reach for an NSAID painkiller. Consider alternative therapies such as lying down, meditation, or another medication such as Paracetamol.
2) Use a Lower Dose if possible. In the study, high dose NSAIDs was particularly harmful for ibuprofen (>1200 mg/day) and naproxen (>750 mg/day).
3) Do not use continuously for more than 7 days. The study showed that usage from 8-30 days was particularly harmful. Even though the study did not show that use beyond 30 days further increased risk, more studies will be needed to confirm this.

 

4) Avoid NSAIDs painkillers have you have pre-existing heart disease, or are at high risk of a heart attack (e.g. family history, smoking)
Reference:
Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data BMJ 2017357 doi:(Published 09 May 2017)Cite this as: BMJ 2017;357:j1909

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