Nonsteroidal anti-inflammatory drugs (NSAIDs) have long been known to increase the risk of heart attack or stroke. “Examples of NSAIDs include ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, others), and prescription NSAIDs such as diclofenac sodium (Voltaren, Solaraze, others) and celecoxib (Celebrex),” the Mayo Clinic noted in a 2015 article. “More research is needed to determine whether some NSAIDs are more or less likely to increase these risks than others.”
A new study in the BMJ (formerly British Medical Journal), which draws upon data from 446,763 people — 61,460 of whom had “acute myocardial infarction,” or heart attack — parses out some of those associated risks.
“In those who used NSAIDs one to seven days, the risk of heart attack increased 24 percent for celecoxib (Celebrex), 48 percent for ibuprofen (Advil, Motrin), 50 percent for diclofenac (Voltaren), and 53 percent for naproxen (Aleve),” reports the New York Times. “The increase for rofecoxib (Vioxx), which was taken off the market in 2004 because of its cardiovascular risks, was 58 percent.” The study found that patients who took NSAIDs were at risks between 20 and 50 percent higher for heart attack than those who didn’t take the drugs.
Michèle Bally, an epidemiologist and the lead study author, told Medscape that the research confirms what physicians already knew, “that patients should use the smallest possible dose for the shortest possible time.” The study found the heart-attack risk decreased with time, but the findings aren’t sufficient to conclude about long-term risks.
“If you average people with different baseline heart risks, the risk specifically due to an NSAID is only about 1 percent per year,” she told Medscape, “so out of 100 people treated continuously for a year, there will be one extra heart attack.”
“I want people to have a conversation with their doctor. People are often not aware of their own baseline cardiovascular risk. You may want to stay with NSAIDs, or you may want to consider other treatments,” she added in an interview with the Times. “Read the label and use the lowest possible effective dose.”
One thing that caught researchers by surprise was the rate at which heart-attack risk escalated during the first week of NSAID use. During that time frame, the probability of increased risk for NSAID takers was larger than 90 percent for all of the anti-inflammatory drugs. It was “somewhat surprising,” Bally told Medscape. “We didn’t anticipate that necessarily.”
Mike Knapton, associate medical director at the British Heart Foundation, noted that the risks could present particular problems for RA patients. “A particularly difficult decision will be in patients with inflammatory arthritis — such as rheumatoid arthritis — as they often need NSAIDs to damp down the inflammation to control pain and stiffness in the joints,” he said, as quoted in NBC News.
More work needs to be done, however. A pharmacoepidemiology professor at the London School of Hygiene and Tropical Medicine quoted in the Guardian that the study, although it presented “good quality, observational research,” also could be blown out of proportion.
“This study suggests that even a few days’ use is associated with an increased risk, but it may not be as clear as the authors suggest. The two main issues here 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,” he said, adding that the study offered “no reason to induce anxiety in most users of these drugs.”