Common painkillers bad for the heart

Doctors have been warned about the dangers to patients’ hearts of prescribing commonly used painkillers on a medium or long term basis.

Ever since rofecoxib – a COX-2 inhibitor type painkiller - was withdrawn from the market after a trial found that it increased the risk of heart disease, there has been concern about the cardiovascular safety of both the new generation COX-2 inhibitors and traditional non-steroidal anti-inflammatory drugs (NSAIDS). Long-term use of the drugs is already associated with liver and gut problems.

A study published in the BMJ has brought all the randomised-controlled trials of these drugs together. All together the researchers in Switzerland analysed 31 trials and 116,429 patients taking seven different drugs (the NSAIDs, naproxen, ibuprofen and diclofenac and the COX-2 inhibitors, celecoxib, etoricoxib, rofecoxib and lumiracoxib).

It should be stressed that the total number of harmful outcomes compared to placebo was low. So, concludes the BMJ, ‘the absolute risk of cardiovascular problems among people taking painkillers was low, but the researchers did find that, relative to placebo, the drugs carried important risks’.

For instance, compared with placebo, rofecoxib and lumiracoxib were associated with twice the risk of heart attack, while ibuprofen was associated with more than three times the risk of stroke. Etoricoxib and diclofenac were associated with the highest (around four times) risk of cardiovascular death.

Naproxen appears safest

As it stands, Naproxen appears least dangerous in terms of heart safety among the seven drugs studied (although there is currently a trial called PRECISION going on comparing it with celecoxib and ibuprofen).

All these names are the drugs’ generic names not the brand names under which they are marketed. Naproxen is marketed under various names including: Aleve, Anaprox, Antalgin, Feminax Ultra, Flanax, Inza, Midol Extended Relief, Miranax, Nalgesin, Naposin, Naprelan, Naprogesic, Naprosyn, Narocin, Proxen, Synflex, Xenobid.

The researchers conclude: ‘Although uncertainty remains, little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms.’ This is a curiously roundabout way of saying these drugs are potentially dangerous but this is what it boils down to. ‘Cardiovascular risk needs to be taken into account when prescribing any non-steroidal anti-inflammatory drug,’ the researchers advise.

These drugs are often prescribed on a long-term basis for people with musculoskeletal diseases such as arthritis. An accompanying editorial in the BMJ says these heart risks are particularly worrying because many patients with musculoskeletal diseases also have heart disease. The journal suggests that it is time for an evaluation of a broader range of alternatives.