A leading heart expert is calling for painkillers like ibuprofen to only be sold in pharmacies in limited quantities and low dosage due to research showing they are linked to an increased risk of cardiac arrest.
Professor Gunnar H. Gislason, of Copenhagen University, conducted a study investigating the link between using non-steriodal anti-inflammatory drugs (NSAIDs) and heart attacks over a 10-year period.
All patients who had an out-of-hospital cardiac arrest in Denmark between 2001 and 2010 were identified from a national registry.
The study found that of the 28,947 patients who had an out-of-hospital cardiac arrest - 3,376 had been treated with a NSAID up to 30 days before the event. Ibuprofen and diclofenac were the most commonly used NSAIDs, making up 51% and 22% of total NSAID use, respectively.
The findings move the debate around the use of NSAIDs on from previous studies showing they are linked to increase cardiovascular risk to actually having a heart attack. NSAIDs are among the most commonly used drugs worldwide and some, including ibuprofen, are available over the counter.
Professor Gislason said: “The findings are a stark reminder that NSAIDs are not harmless,
“Diclofenac and ibuprofen, both commonly used drugs, were associated with significantly increased risk of cardiac arrest. NSAIDs should be used with caution and for a valid indication. They should probably be avoided in patients with cardiovascular disease or many cardiovascular risk factors.”
He added: “I don’t think these drugs should be sold in supermarkets or petrol stations where there is no professional advice on how to use them. Over-the-counter NSAIDs should only be available at pharmacies, in limited quantities, and in low doses.
“Do not take more than 1200 mg of ibuprofen per day. Naproxen is probably the safest NSAID and we can take up to 500 mg a day. Diclofenac is the riskiest NSAID and should be avoided by patients with cardiovascular disease and the general population.”
NSAIDs exert numerous effects on the cardiovascular system which could explain the link with cardiac arrest. These include influencing platelet aggregation and causing blood clots, causing the arteries to constrict, increasing fluid retention, and raising blood pressure. Use of any NSAID was linked with a 31% increased risk of cardiac arrest. Diclofenac and ibuprofen were associated with a 50% and 31% increased risk.