Heart attack survivors should be wary about taking a common group of painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs), say Danish researchers reporting in the journal Circulation this week, because the drugs could increase longer term risk of a second heart attack, or even death.
NSAIDs include over the counter painkillers such as ibuprofen and naproxen, and prescription medication like celecoxib (Celebrex) which is used to treat arthritis, pain, menstrual cramps, and colonic polyps.
Lead author Anne-Marie Schjerning Olsen, a fellow in the cardiology department at Copenhagen University Hospital Gentofte, and colleagues also suggest the raised risk could persist for up to five years after a heart attack.
Reflecting on the implications for doctors and patients, Schjerning Olsen told the media:
“It is important to get the message out to clinicians taking care of patients with cardiovascular disease that NSAIDs are harmful, even several years after a heart attack.”
Although the researchers didn’t carry out a controlled clinical trial, which would have been a more robust way to arrive at these conclusions, they are confident the likely culprits behind the raised risk are NSAIDs, and not some other unknown factors.
For their study, Schjerning Olsen and colleagues used Danish national hospital and pharmacy registries to find nearly 100,000 people aged 30 and over who experienced a first heart attack during 1997 to 2009 inclusive. They were also able to see from these records which of the participants had been prescribed NSAIDs afterwards.
They found 44% of the participants had received at least one prescription for NSAIDs.
They then analysed the data relative to deaths and to rule out other factors known to affect risk of death or a further heart attack, such as other diseases and medications, or differences in age, gender, income and year of hospitalization.
This revealed that having a prescription for NSAIDs was linked to a 59% higher risk of death from any cause one year after a first heart attack and 63% higher after five years.
The analysis also showed that the risk of a second heart attack, or of dying from coronary heart disease (where the small blood vessels that supply blood and oxygen to the heart get too narrow), was 30% higher after one year and 41% higher after five years.
Schjerning Olsen said the findings support other studies that suggest NSAIDs appear to have no “safe treatment window” in heart attack patients, and this is true for several years after the event.
Normally, people who have a heart attack can expect to have a higher risk of a second attack or dying within the first year, but this wears off such that five to ten years later it is no greater than anyone else’s. But these findings suggest NSAIDs could change this for the worse.
Schjerning Olsen warns that “long-term caution with any use of NSAIDS is advised in all patients after heart attack”.
In 2007 the American Heart Association said in a statement that doctors should be careful to weigh up the risks versus the benefits when thinking about using NSAIDs in patients who have cardiovascular disease or who are at least of high risk of developing it.
Schjerning Olsen urges a rethink on the use of NSAIDs and whether they should be easily available over the counter.
She says the public generally assume that when drugs are available over the counter, this means they are safe. But “a strong signal of safety … may be contrary in this case,” she adds.
Written by Catharine Paddock PhD