Painkillers 'increase' heart and stroke risk

COMMONLY used painkillers increase the risk of heart attacks and strokes when taken at high doses or over the long term, according to new research.

Experts analysed more than 30 clinical trials on more than 116,000 patients to examine the effects of painkillers on people's health. The fears relate to non-steroidal anti-inflammatory drugs (NSAIDs) as well as newer anti-inflammatory drugs known as COX-2 inhibitors, and reflect previous studies.

In the latest analysis, the medicines naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib and lumiracoxib were scrutinised. Doctors regularly prescribe them to treat painful conditions, including osteoarthritis, and are given at much higher doses than those found in over-the-counter remedies, which are used for occasional headaches, aches and pains.

The latest study, published in the British Medical Journal (BMJ), found that compared with a dummy drug, lumiracoxib increased the risk of heart attacks while ibuprofen was linked to the highest risk of stroke (more than treble the risk).

Diclofenac almost tripled the risk, while etoricoxib and diclofenac were associated with around a fourfold increased risk of suffering death from cardiovascular causes. Rofecoxib more than doubled the risk of heart attack, the researchers noted.

This drug (brand name Vioxx) was withdrawn in 2004 when other studies found it raised the risk of heart attacks.

The authors, from the University of Bern in Switzerland, concluded: "Although uncertainty remains, little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms. Naproxen seemed least harmful.

"Cardiovascular risk needs to be taken into account when prescribing any non-steroidal anti-inflammatory drug."

Overall, the number of heart attacks and strokes reported was low compared to the number of patients.

In 29 of the trials, there was a total of 554 heart attacks and in 26 trials there were 377 strokes. In 28 trials there were 676 deaths.

But in an accompanying editorial, Professor Wayne Ray, from the department of preventive medicine in Nashville in the US, said the excess risk "should prompt evaluation of a broader range of alternatives".