People with a history of heart attack are at increased risk of suffering another attack or dying after even a week of taking certain types of prescription and over-the-counter painkillers, including Advil, Motrin or Voltaren, a large recent study suggests.
Danish researchers analyzed nationwide records of nearly 84,000 heart attack survivors and found that those who used certain nonsteroidal anti-inflammatory drugs (NSAID) for one week faced a 45% heightened risk of another heart attack. Three months' use raised the risk to 55%.
The results reinforce a 2007 American Heart Association statement advising doctors about the risk of NSAID use among heart patients and recommending the drugs be used only in the lowest dose and for the shortest duration necessary.
"The present results indicate there is no apparent safe therapeutic window for NSAIDs in patients with prior [heart attack), and challenge the current recommendations of low-dose and short-term use of NSAIDs as being safe," said study author Anne-Marie Schjerning Olsen, MB, a research fellow at Copenhagen University in Denmark.
Among the nearly 84,000 heart attack survivors analyzed, whose average age was 68, more than 42% had at least one prescription for an NSAID, according to the study.
The most common NSAIDs prescribed to study participants were ibuprofen (Advil, Motrin) and diclofenac (Cataflam, Voltaren). Diclofenac carried the highest cardiovascular risk, even greater than rofecoxib (Vioxx), an NSAID banned in the United States in 2004 because of a higher rate of heart attacks and strokes among those taking it.
The US Food and Drug Administration recently issued a warning that diclofenac should not be used by patients recovering from heart surgery.
"We were surprised that commonly used NSAIDs such as diclofenac, which in some countries is available over the counter without any expert advice on potential side effects, were associated with increased risk...and the risk continued to persist during the course of treatment," Dr. Olsen said.
One popular NSAID, naproxen (Aleve), was not associated with a greater risk of death or recurrent heart attack in the study, although it has been linked to gastrointestinal bleeding.
The study was published in the journal Circulation.
Heart patients will sometimes use NSAIDs despite the risks if they suffer severe pain from conditions such as rheumatoid arthritis or lupus, said Elliott Antman, MD, professor of medicine at Brigham and Women's Hospital and Harvard Medical School, both in Boston.
Nondrug pain relief methods, such as physical therapy, heat and splints, or other types of pain relievers should be tried before resorting to NSAIDS, he said.
"Some patients have such debilitating arthritis that we need to work down the list (of NSAIDs), recognizing as we get down the list we're getting into increasingly dangerous territory," Dr. Antman said.
"If they're on one, they shouldn't stay on it. Many doctors don't monitor medication use and patients stay on long past flare-ups."