High painkiller doses found to raise risk of heart attack or stroke

Prolonged higher-dose use of some non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac and ibuprofen, ups the likelihood of having a heart attack or a stroke, a study found.

The research, carried out by the MRC Clinical Trial Service Unit & Epidemiological Studies Unit at the University of Oxford and published in The Lancet, is based on data from outcomes of more than 353,000 patients.

NSAIDs are among the most commonly-used drugs in the world and are widely used to manage pain by people suffering from conditions such as rheumatoid arthritis and osteoarthritis.

The research found that for every 1,000 people with a moderate risk of heart disease allocated one year of treatment with high-dose diclofenac (150mg daily) or ibuprofen (2400mg daily), about three would experience an avoidable heart attack, of which one would be fatal.

The study also found that all NSAIDs double the risk of heart failure and produce a two-four times increased risk of serious upper gastrointestinal complications such as bleeding ulcers.

Analysis of the data from 639 random trials shows that the size of the risks can be predicted, which may help doctors decide which types of patient are suited to which types of painkiller.

Lead author Professor Colin Baigent said the risks are relative to an individual’s existing risk of heart disease.

He said: “What we found was that there’s an extra risk of heart attacks but it’s higher in people who have an underlying risk of heart disease.

“By having the information that we need about a person’s risk of heart disease, we can predict their extra risk of heart attacks when they take one of these drugs.”

Prof Baigent was keen to point out that the risks discovered are “really low” and apply to very high doses of the drugs, and he also urged people using high doses not to worry.

He added: “They certainly shouldn’t panic. We’re talking about really low risks. The e xtra risk of a heart attack is very small.

“But if they are worried they could go and talk to their GP about it and they can consider if the risks – which are real but small – are worth it for them.”

Professor Alan Silman, medical director of Arthritis Research UK, called on arthritis sufferers “not to be unduly concerned”.

He said: “GPs are aware of the risks of NSAIDs, and there has been a marked reduction in the use of diclofenac and a switch to naproxen in recent years.

“For patients with arthritis, not smoking, a healthy diet and having their blood pressure checked regularly are more important factors in reducing the risk of a heart attack.”