Over-the-counter painkillers may raise stroke and heart attack risk

NSAIDS such as aspirin and ibuprofen sell in their millions every day, but now reasearch suggests they could raise heart attack and stroke risk in some groups.

Grouped together, they go by the awkward acronym of NSAIDs. In medical longhand they're "non-steroidal anti-inflammatory drugs". But to most of us whose daily interaction with medicine is little more than buying painkilling pills at the chemist or supermarket, they're better known by names such as aspirin, ibuprofen or naproxen.

Today NSAIDs are one of the most widely used classes of drugs, with annual sales exceeding Dh66 billion worldwide. But despite their commercial success, frequent use of NSAIDs can cause well-documented gastrointestinal side effects, including ulcers and bleeding.

Still these pills are, as their acronym implies, designed to reduce inflammation and so, for millions of people around the world, are the first choice of medication when fighting fevers or seeking pain relief from headaches or chronic conditions such as arthritis.

But now there's an additional fear among health professions that over-the-counter NSAIDs could increase the risk of heart attack or stroke.

Research published in the British Medical Journal (BMJ) has supported claims that certain types of painkillers used to treat inflammation could double or even treble the risk of heart attack and stroke in people already vulnerable to such conditions.

A study carried out by a team at the University of Berne, in Switzerland, which involved a review of 31 separate, long-term drug trials with a total of 116,429 participants, looked into how NSAIDs such as ibuprofen, naproxen and lumiracoxib, among others, could influence cardiovascular health.

The findings show that ibuprofen can treble the risk of stroke while diclofenac - which is available under many trade names including Voltarol, Cataflam and Artifen - was linked to a four-fold increase in risk of death from heart attack or stroke. The same was true of Etoricoxib - which is marketed as Arcoxia, Algix, Tauxib and Etosaid in different parts of the world.

Of the seven leading NSAIDs tested, including celecoxib (sold as Celebrex), etoricoxib (Arcoxia), rofecoxib (Vioxx) and lumiracoxib (Prexige), the researchers concluded that naproxen - which you may know better as Aleve, Feminax Ultra or Midol - is the least harmful.

However, the research team has also been quick to point out that not everyone who takes these painkillers will be suddenly trebling or quadrupling their chances of dropping down dead from a fatal blood clot or heart attack.

"If you're taking these NSAIDs for conditions such as a headache, and you are under 65 years old, you don't have a history of heart problems, you have normal cholesterol and you don't smoke, it's probably fine," Professor Peter Juni, the head of the university's preventive medicine department, told the medical media.

"The problem is for older people taking regular NSAIDs for chronic pain and who have heart trouble," he insisted. "For these people, the estimated annual risk of death from cardiovascular disease is already 1-2 per cent. Taking these drugs will increase that risk."

It's not the first time this issue has been raised. In 2004, one class of NSAIDs that also featured in the Swiss research - rofecoxib, sold as Vioxx - was withdrawn from sale because of concerns over cardiovascular safety.

In the UK the Medicines and Healthcare Products Regulatory Agency (MHRA) monitors all suspected adverse drug reactions. Its advice is to use NSAIDs sparingly. "Current evidence does not suggest an increased risk of heart attacks or stroke for short-term, low dose treatment with ibuprofen," said Yetunde Akintewe, an MHRA representative. "To minimise the risk of side-effects, all NSAIDs should be used at the lowest possible dose for the shortest period necessary to control symptoms."

If you've been prescribed aspirin to prevent blood clots, the advice for now from the MHRA is to keep taking it - or at least to talk to your doctor before stopping. This is backed up by a report in the July issue of the BMJ, which warns that discontinuing "aspirin therapy" could lead to an increased risk of heart problems if you have been advised to take the pills on medical grounds.

This UK study behind that report, of nearly 40,000 people aged 50-84 with a history of cardiovascular disease and prescribed low-dose aspirin, found that people who had stopped using aspirin had a 63 per cent higher risk of a non-fatal heart attack. The study authors concluded that, among people with a history of cardiovascular events, those who stop taking low-dose aspirin have a higher risk of non-fatal heart attack than people who continue aspirin therapy.

The confusion over NSAIDs has rung alarm bells among groups representing people for whom they provide essential long-term chronic pain relief.

"NSAIDs can be extremely effective for people with arthritis," said Jane Tadman, of the support group Arthritis Research UK. "The other alternatives - such as paracetamol, which is recommended for first-line use in osteoarthritis before NSAIDS - are not always as effective."

But, she added: "Advice to take the lowest possible dose for the shortest period of time is not particularly useful to those in extreme, chronic pain. There is a huge gap in the market for side-effect-free effective painkillers that can be taken safely over a long period of time."