Anti-Inflammatory Drugs Lower the Pain but Rise the Risk of Heart Problems

Swiss researchers carried out a meta-analysis of the cardiovascular safety of non-steroidal anti-inflammatory drugs (NSAIDs) and the new generation anti-inflammatory drugs called COX-2 inhibitors, and concluded that they might present a cardiovascular risk.

The study published on bmj.com today, revealed that commonly used painkillers for treating inflammation, can rise the risks of heart attacks and strokes, so doctors and patients need to take into account any cardiovascular risks before prescribing/taking any anti-inflammatory drugs.

The researchers conducted a comprehensive analysis of all randomized controlled trials, and compared any NSAID with other NSAIDs or placebo.

Their study included 31 trials and 116,429 patients, taking seven different drugs – celecoxib, diclofenac, etoricoxib, ibuprofen, lumiracoxib, naproxen and rofecoxib, or placebos, in order to obtain a more reliable estimate of the cardiovascular risks of these drugs, compared to previous studies.

Analysis results showed that the number of dangerous outcomes that could be compared for placebo versus treatment was relatively low – in 29 trials there was a total of 554 heart attacks, in 26 trials there were 377 strokes, and in 28 trials there were 676 deaths.

So researchers say that even though the absolute risk of cardiovascular problems among people taking painkillers was low, compared to placebo, the drugs still bore important risks.

They explain that compared to placebo, rofecoxib and lumiracoxib were associated with a double risk of heart attack, while ibuprofen was associated with over three times the risk of stroke.

Etoricoxib and diclofenac were associated with four times (the highest) the risk of cardiovascular death, and the only one that appeared least harmful in terms of cardiovascular safety among the seven analyzed preparations, was naproxen.

NSAIDs have been the basis of pain management in patients with osteoarthritis and other painful conditions, but in 2004, the COX-2 inhibitor rofecoxib was withdrawn from the market after a trial found it increased the risk of cardiovascular disease.

Ever since, the cardiovascular safety of COX-2 inhibitors and traditional NSAIDs has been a constant debate and no previous studies have been able to give a precise verdict.

This latest trial had a low number of cardiovascular events, but the authors say that “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.”

This study is accompanied by an editorial that pulls the alarm signal and says that many patients have both cardiovascular disease and musculoskeletal disease, so their risks are far higher.

The way things present themselves, maybe it's time for assessing a wider range of alternatives.