Many of us commonly use painkillers to squelch the common headache or relieve back pains. However it has been found that even over the counter ibuprofen (Advil, Medipren, Motrin, Nuprin, PediaCare) can increase stroke risk by three times and drugs such as rofecoxib (Vioxx) and lumiracoxib (Prexige) can double the risk of heart attack. NSAIDs are commonly prescribed for the inflammation of arthritis and other body tissues, such as in tendinitis and bursitis.

Pain, fever, and inflammation are promoted by the release in the body of chemicals called prostaglandins. Ibuprofen, for example, blocks the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower levels of prostaglandins. As a consequence, inflammation, pain and fever are reduced.

A study published today by the British Medical Journal online examined the effect of include traditional non-steroidal anti-inflammatory drugs (NSAIDs) as well as new generation anti-inflammatory drugs, known as COX-2 inhibitors and risk associated with heart attack and stroke.

Doctors and patients need to be aware that prescription of any anti-inflammatory drug needs to take cardiovascular and stoke risks into serious consideration.

The Swiss authors of the study state:

"Our study provides the best available evidence on the safety of this class of drugs. 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."

The medical scientists performed an analysis of all randomized controlled trials comparing any NSAID with other NSAIDs or placebo. Thirty one trials were completed in 116,429 patients.

When 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 (Arcoxia) and diclofenac (Rufenal) were associated with four times the risk of cardiovascular death.

In 2004, the COX-2 inhibitor rofecoxib was withdrawn from the market after a trial found that the drug increased the risk of cardiovascular disease. Since then, there has been much debate about the cardiovascular safety of COX-2 inhibitors and traditional NSAIDs, which several studies have not been able to resolve.

Many patients have both cardiovascular disease and musculoskeletal disease making NSAIDs both necessary and controversial. Other medical professionals suggest that it is time for an evaluation of a broader range of alternatives.

Research: Professor Peter Jüni, Head of Division, Institute of Social and Preventive Medicine, University of Bern, Switzerland

Written by Sy Kraft, B.A.