In a latest study published on bmj.com today, the authors concluded that an increased risk of irregular heart rhythm, also known as atrial fibrillation or flutter, can be attributed to common painkillers that are used to treat inflammation.
The painkillers comprise of new generation anti-inflammatory drugs known as selective COX-2 inhibitors as well as non-selective non-steroidal anti-inflammatory drugs (NSAIDS).
Atrial fibrillation is a condition associated with an augmented long term risk of stroke, heart failure, and death.
Although these drugs have already been associated with an increased risk of heart attacks and strokes, no study has been conducted to demonstrate the increase in risk of atrial fibrillation.
Led by Professor Henrik Toft Sørensen, a team of researchers at the Aarhus University Hospital in Denmark used the Danish National Registry of Patients and identified 32,602 patients with primary diagnosis of atrial fibrillation between 1999 and 2008.
Each case was compared with 10 control patients who were randomly selected people from the Danish population comparable to the patient with respect to age and sex.
NSAID users were classified as either current or recent. Current users, who had their first ever prescription within 60 days of diagnosis date, were further classified as new users or long-term users.
An increase in the risk of atrial fibrillation or flutter was directly associated with use of NSAIDs or COX-2 inhibitors as determined by researchers.
The association was found to be the strongest for new users, as compared with non users, with an increased risk of approximately 40% and 70% for non-selective NSAIDS and COX-2 inhibitors, respectively.
This is comparable to approximately four and seven extra cases of atrial fibrillation per year per each 1000 new users of non-selective NSAIDS and of COX-2 inhibitors, respectively.
Although older people were at the highest risk, on commencing treatment with COX-2 inhibitors, patients with chronic kidney disease or rheumatoid arthritis were also found to be at a particular risk.
“Our study thus adds evidence that atrial fibrillation or flutter need to be added to the cardiovascular risks under consideration when prescribing NSAIDs,”
concluded the authors.
Professor Jerry Gurwitz from the University of Massachusetts Medical School in the US supports this view in an accompanying editorial. He reckons that irrespective of whether an association between NSAIDs and atrial fibrillation actually exists or not, patients with a history of hypertension or heart failure should be very cautious about their use of NSAIDS.
Source: British Medical Journal
Written by Anne Hudsmith