Charlie Cooper
Some of the most commonly used painkillers can increase long-term users’ heart-attack risk by more than a third, an in-depth study into their side-effects has shown.
One year’s high-dose treatment with over-the-counter painkillers such as ibuprofen and diclofenac, used by hundreds of thousands of arthritis sufferers in the UK, leads to three avoidable heart attacks and one fatal heart attack for every 1 000 users, researchers said.
The group of drugs, known as non-steroidal anti-inflammatory drugs (NSAIDs), have also been linked with gastrointestinal conditions such as stomach ulcers.
A new generation of NSAID painkillers, known as coxibs, had been introduced. It carried a lesser risk of stomach pains, but they were widely linked to an increase in heart attacks, leading to widespread public concern and the withdrawal of the popular drug Vioxx from shelves in 2004.
Now, however, the study’s authors believe that high-dose treatments with older NSAIDs – like daily 150mg prescriptions of diclofenac or 2 400mg prescriptions of ibuprofen – could be as big a risk factor for heart attacks as Vioxx.
All NSAIDs, the authors said, doubled the risk of heart failure and produce a two to four-times increased risk of gastrointestinal complications.
“We had huge public concern about Vioxx at a time when it wasn’t clear that other drugs that had been on the market for years have similar risks,” said the report’s main author, Professor Colin Baigent, of the University of Oxford’s clinical trial service and epidemiological units.
The study, published in The Lancet medical journal, could lead to a review of the prescriptions offered by the NHS, particularly to patients with pre-existing heart problems.
One painkiller, naproxen, did not significantly increase the risk of heart attack and could now be favoured over more common drugs.
Baigent said the study would give GPs and patients greater clarity about the risks involved in long-term painkiller use. “Patients taking high doses may want to speak to their GP or rheumatologist,” he said.
Many of the 7 million people in the UK who suffer from osteoarthritis, and the 400 000 who suffer from rheumatoid arthritis, take high doses of ibuprofen, diclofenac or other NSAIDs, with many reliant upon the pain relief to go about their daily lives.
GPs welcomed the study, but said it was important to keep the findings “in context”.
“Pain blights the daily lives of millions of people and treatments such as ibuprofen can vastly improve the quality of their lives, if used properly,” said chairwoman of the Royal College of General Practitioners Clare Gerada.
The study, which analysed 639 random drug trials and gathered data on more than 350 000 patients, found for every 1 000 arthritis sufferers, the rate of people suffering a “major vascular event” such as heart attack, stroke or death increased from eight in 1 000 to 11 in 1 000 with long-term, high-dose use of common NSAIDs. – The Independent