TUESDAY, Jan. 11 (HealthDay News) -- Common painkillers taken to
treat inflammation, such as Celebrex and Advil, can raise the risk
of heart attack, stroke or death, a review of existing research
Swiss researchers analyzed the results of 31 trials involving
seven non-steroidal anti-inflammatory drugs (NSAIDs), as these
medications are called, and concluded that cardiovascular risk
needs to be considered before prescribing any of them.
"NSAIDs are widely used worldwide for treating pain and inflammation," said Dr. Gregg Fonarow, American Heart Association spokesman and professor of cardiology at the University of California, Los Angeles.
"A number of studies have shown that many of these agents are associated with increased risk of cardiovascular events, particularly when used at higher doses and for longer periods of time, but uncertainty remains as to the magnitude of the risk and how the cardiovascular risk may vary among different NSAIDs," said Fonarow, who was not involved in the study.
All the NSAIDs studied increased the risk of cardiovascular
events, but the magnitude of risk is small in absolute terms --
approximately one cardiovascular event per 100 patient-years of
follow-up, Fonarow noted.
"In many patients the benefits provided by these agents may outweigh the risk, and other steps can be taken to reduce the patient's cardiovascular risk," he said.
The report is published in the Jan. 11 online edition of the
In 2004, the drug Vioxx (rofecoxib), which belonged to a class
of NSAIDs called COX-2 inhibitors, was pulled from the market
because of its link to an increased risk of heart attack.
To explore the connection between NSAIDs and heart problems, a
team led by Dr. Peter Juni, from the Institute of Social and
Preventive Medicine at the University of Bern, reviewed 31 trials
that included 116,429 patients. This method of reviewing trial
findings to uncover a pattern is called a meta-analysis.
The painkillers the patients were taking included naproxen
(Aleve), ibuprofen (Advil, Motrin), diclofenac (Voltaren,
Cataflam), celecoxib (Celebrex), etoricoxib (Arcoxia), rofecoxib
(Vioxx), lumiracoxib (Prexige) or placebo.
Overall, the number of heart events among patients taking NSAIDs
was low, the researchers found. In 29 trials, 554 heart attacks
occurred. In 26 trials, 377 strokes were reported, and in 28
trials, 676 people died.
Compared with patients taking placebo, those taking rofecoxib
and lumiracoxib had twice the risk of heart attack, and those
taking ibuprofen had more than three times the risk of stroke. The
highest risks for cardiac death were associated with etoricoxib and
diclofenac, where the risk was around four times greater than for
placebo, the researchers found.
Naproxen appeared to be the least harmful medication, they
"Our study provides the best available evidence on the safety of this class of drugs," the researchers wrote. "Although uncertainty remains, little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms. Cardiovascular risk needs to be taken into account when prescribing any non-steroidal anti-inflammatory drug," they concluded.
Commenting on the study, Dr. Eric J. Topol, director of the
Scripps Translational Science Institute and one of the experts who
uncovered the risks associated with Vioxx, said a meta-analysis can
leave many questions unanswered but is of value nonetheless.
"Pooling large data sets like this winds up with ambiguity as it homogenizes differences in patient population characteristics, dose of drugs, how endpoints were ascertained and when, etc.," he said. "I am not sure if the conclusions reflect or agree with other meta-analysis results," Topol noted.
"Despite the limitations, this study has made many excellent contributions on the NSAID issue, so we need to factor these into the mix," Topol said.
For more information on NSAIDs, visit the
U.S. Food and Drug Administration.