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Common painkillers linked to heart attack risk

Twitter: @helena_fordham

Headache, toothache, flu? Pop a pill! Many of us will have taken non-steroidal anti-inflammatory drugs (NSAIDs). They are convenient, inexpensive and widely available without a prescription. However, recent research suggests that NSAIDs could increase your risk of a heart attack  by as much as 50%.  So, are the stories in the media just scaremongering, or is there some truth behind these headlines?

 What are NSAIDs?

NSAIDs are medications commonly used to reduce inflammation, a high temperature (fever) and alleviate pain. Commonly used NSAIDs include naproxen, ibuprofen, diclofenac, and high-dose aspirin (low doses are not usually considered a NSAID, but that’s another story).  Without being too scientific, when trauma or infection strikes, the body responds by producing prostaglandin hormones. These hormones cause inflammation and pain, which NSAIDs block the production of.

The Research

The research in question was published in the British Medical Journal earlier this year. This was meta-analysis (the gold standard of medical research), collecting data of NSAID consumption from several observational studies. In total almost half a million patients were included. The data was then analysed to compare NSAID consumption between patients who had had a cardiac event against those who had not.

The results of the study were mixed. But overall, the results suggest that: commonly-used NSAIDs may increase heart attack risk compared to patients who had not used them in the previous year. Also, ibuprofen increased risk by 48%, which increased further if the dose exceeded 1200mg a day.

Nevertheless, closer inspection reveals some limitations that question the validity of these results:

  • Only patients prescribed NSAIDs were included in the meta-analysis; those taking  NSAIDs over-the-counter (without prescription) were excluded. Given the availability of NSAIDs, the results may not be representative of the general population.
  • Observational studies (as the name suggests) observe the exposure effect. In other words, the research is not conducted in a controlled environment. This means that variables such as smoking and BMI could affect the results.
  • Heart attack risk at ‘baseline’ is not provided in the paper; therefore, we don’t know if the patients in this meta-analsysis were at high risk of a heart attack before taking NSAIDs.

What now?

Despite this study’s limitations, the results do suggest increased cardiac risk for some NSAIDs for some of the population. That risk increases with dose and remains at its highest point during the first month. These findings are supported by NICE (National Institute for Health and Care Excellence), who confirm that there is substantial evidence to link NSAID consumption and heart attacks. However, the risky high doses should only be taken under the direction of a qualified medical professional. If you are at risk of a cardiovascular event, or feel you that might be, it’s important to speak to your GP before taking such medications.

Whilst this may sound rather daunting, there is no need to panic if you are generally in good health.  Short-term, low-dose NSAIDs are safe for many people when self-treating common ailments.  But, should you find yourself reaching for the painkillers regularly, it may be worth speaking to your doctor about the many available alternatives.

Any opinions above are the author’s alone and may not represent those of his/her affiliations. Any comment is based on the best available evidence at the time of writing.  All data is based on externally validated studies unless expressed otherwise. Novel data is representative of sample surveyed. Online recommendation is no substitute for seeing your own doctor and should not be taken as medical advice.

Image courtesy of Pixabay

Links and further reading:

http://www.dailymail.co.uk/health/article-4314716/Heart-attack-fears-use-common-painkillers.html

https://www.gov.uk/government/publications/cox-2-selective-inhibitors-and-non-steroidal-anti-inflammatory-drugs-nsaids-cardiovascular-safety/cox-2-selective-inhibitors-and-non-steroidal-anti-inflammatory-drugs-nsaids-cardiovascular-safety

http://www.nhs.uk/news/2017/05May/Pages/Ibuprofen-linked-to-increased-risk-of-heart-attacks.aspx

http://www.bmj.com/content/bmj/357/bmj.j1909.full.pdf

https://www.nice.org.uk/advice/ktt13/chapter/evidence-context

https://www.nice.org.uk/guidance/cg183/chapter/Introduction

https://patient.info/health/painkillers

http://www.nhs.uk/Conditions/Painkillers-ibuprofen/Pages/Introduction.aspx

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About Helena A L Fordham (5 Articles)
MMedSci student in Human Nutrition at the University of Sheffield. BSc (Hons) BA (Hons). Passionate about evidence based research.

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