High doses of some of the most common painkillers, including ibuprofen and diclofenac, can increase the risk of heart problems by nearly thirty percent, according to a new study published in The Lancet.

The researchers conducted a meta-analysis of clinical trials to analyze the risks associated with taking nonsteroidal anti-inflammatory drugs (NSAIDs) -including selective COX-2 inhibitors (coxibs) and traditional non-steroidal anti-inflammatory drugs (tNSAIDs).

NSAIDs are medications with analgesic (pain reducing) and antipyretic (fever reducing) properties.

High-dose NSAIDs are frequently used to treat and manage pain among patients suffering from inflammatory disorders.

Although many patients are willing to accept the risks associated with the medications, they should be fully informed first by their doctor. The results of this study will help them determine whether they are willing to take the risk.

The cardiovascular risks associated with NSAIDs had been explored by researchers before. One study found that heart attack survivors who were prescribed NSAIDs were 45% more likely to die or have another heart attack within one week of treatment.

In order to fully assess the health impacts of NSAIDs and help patients make an informed choice, the investigators thoroughly analyzed results from a total of 639 different clinical trials (which cover 353,000 patients records).

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Ibuprofen a common nonsteroidal anti-inflammatory drug (NSAID)

They identified an increased risk of heart attacks and death among the new generation of NSAIDs “coxibs”, which were associated with a thirty percent increase in the risk of major vascular events.

The effects of high dose prescriptions levels of 150mg diclofenac or 2,400mg ibuprofen each day were analyzed.

A previous study published in PLoS Medicine revealed that naproxen and low dose ibuprofen are least likely to increase cardiovascular risk whereas diclofenac, even in doses available without prescription, elevates risk.

Results of the study showed that every year there were three additional heart attacks, four additional cases of heart failure, and one death for every 1,000 people taking the medications.

Lead researcher Prof Colin Baigent, said:

“Three per thousand per year sounds like it is quite a low risk, but the judgement has to be made by patients.

So if you’re a patient and you go and sit in front of your doctor and discuss it, you are the one who should be making the judgement about whether three per thousand per year is worth it to allow you, potentially, to go about your daily life.”

It’s important to note that this finding shouldn’t alarm or concern people who only use the painkillers for the occasional headache.

Prof Baigent commented that the finding is particularly relevant to people at high risk of heart disease on high doses of NSAIDs, adding that “the higher your risk of heart disease, the higher your risk of a complication. Roughly speaking, if you’ve got double the risk of heart disease, then the risk of having a heart attack is roughly doubled.”

Of all the NSAIDs analyzed, “Naproxen” didn’t appear to increase major vascular events or vascular deaths.

It is crucial that prescribers are aware of the risks associated with these powerful drugs before prescribing them.

Written by Joseph Nordqvist