Common painkillers increase risk of heart problems and death: meta-analysis

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1. Common non-steroidal anti-inflammatory drugs (NSAIDs), including coxibs, ibuprofen and diclofenac, increase major vascular events by ~1/3.

2. These findings are primarily attributable to increases in major coronary events by ~3/4.

3. All NSAIDs double the risk of heart failure and produce a 2–4 times increased risk of serious upper gastrointestinal complications (e.g. ulcers).

4. Vascular death was increased significantly by coxibs and diclofenac.

Study Rundown: NSAIDS are a key part of regimens managing chronic inflammatory and pain disorders, including rheumatoid arthritis. The new generation of NSAIDs, including coxibs, were developed to reduce the traditional gastrointestinal risks associated with previous generations (ibuprofen, diclofenac, naproxen). However, the present meta-analysis of 639 randomized trials confirms previous findings that high dose diclofenac (150mg daily) and ibuprofen (2400mg daily) carry an additional and comparable heart risk to coxibs. While ibuprofen increased major coronary events, it did not increase major vascular events. Naproxen (1000mg daily), did not significantly increase major vascular events. As a large meta-analysis of randomized trials, the study is rigorous in methods and removes much of the inherent bias of observational studies.

Please click to read the study, published today in The Lancet

In-Depth [meta-analysis of randomized controlled trials]: This study analyzed 650 randomized trials, a combination of NSAIDs vs. placebo and NSAIDs vs. NSAIDs. Major vascular events (non-fatal myocardial infarction, non-fatal stroke, or vascular death), major coronary events (non-fatal myocardial infarction or coronary death) as well as upper gastrointestinal complications (perforation, obstruction, or bleed), stroke, mortality, and heart failure were tracked as outcomes. Coxibs, diclofenac, and ibuprofen all increased major vascular events (RR 1.37, 1.41, 1.7, p<.01 for all). While coxibs and diclofenac both increased the risk of vascular death significantly, ibuprofen and naproxen did not reach significance.

By Marc Succi

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