Pain Relievers (NSAIDs) Increase Risk of Heart Disease

Diclofenac (Voltaren, Cataflam) and rofecoxib (Vioxx) were shown in the following study to increase significantly the risk of cardiovascular disease and deaths. Diclofenac increased the risk 91% and rofecoxib inreased the risk 66%. Vioxx was removed from the market in 2004 because of this problem, but diclofenac is still a very popular non-steroidal anti-inflammatory drug.

Even ibuprofen showed a small, dose-dependent trend for increase in cardiovascular risk. The only NSAID that didn't show an increased risk was naproxen.

Two NSAIDs Were Associated With Increase in Heart Risks

by Diana Mahoney

The nonsteroidal anti-inflammatory drugs rofecoxib and diclofenac were linked to increased cardiovascular mortality and morbidity in a nationwide cohort of otherwise healthy Danish residents, while naproxen appeared to be associated with the least cardiovascular risk, researchers reported.

Dr. Emil Loldrup Fosbøl of Gentofte University Hospital in Hellerup, Denmark, and colleagues reported that patients in the study taking the nonselective NSAID diclofenac (Voltaren, Cataflam) had a 91% increased risk of cardiovascular death, compared with patients with no NSAID history, and patients taking the selective cyclooxygenase-2 (COX-2) inhibitor rofecoxib (Vioxx), which was withdrawn from the market in 2004 because of poor cardiovascular safety, had a 66% increased risk.

The investigators also observed a small, dose-dependent trend for increase in cardiovascular risk associated with ibuprofen, while no such relationship was observed with naproxen, they wrote (Circ. Cardiovasc. Qual. Outcomes 2010 June 8 [doi: 10.1161/CIRC OUTCOMES.109.861104]).

The epidemiologic study included data for 1,028,437 individuals, median age 39, collected from 1997 through 2005. Approximately 45% of the cohort had a history of some NSAID use during this time....

Ibuprofen showed a dose-dependent association with coronary and stroke event risk in the Cox analyses, with a decreased risk of coronary death, nonfatal MI, and stroke in low doses and trend for increased risk in high doses, and, as in the crossover analysis, “naproxen was associated with a trend for neutral or decreased risk of all the examined end points,” they wrote.

In repeat analyses conducted on a population of NSAID users and sex-, age-, and time-matched NSAID nonusers, a trend for a higher increase in cardiovascular risk was associated with use of all of the NSAID drugs, the authors reported.
Disclosures: The authors report no financial conflicts relevant to this investigation.

Family Practice News, Volume 40, Issue 12, p. 18 (July, 2010)

Dr. Judi here: NSAID use has shown increased risk of ulcers and intestinal bleeding which has lead to death, increased risk of kidney failure which has lead to death, increased risk of kidney cancer which has lead to death, and now increased risk of heart disease.  As with any drug, even over-the-counter medications, do your homework and make sure that the benefit of taking them is greater than the risk.

When people are in pain now, it is hard to ignore the painkilling effects of NSAIDS.  Acetaminophen has it's own problems causing liver damage and failure.  What can be used instead, without going on to opiate medications?  This will be addressed in future blogs.

Until we meet again,
Dr. Judi