NSAIDs Increase Heart Failure Risk
Non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen, diclofenac, ponstan and ibuprofen are commonly used drugs for the treatment of pain and fever. They also commonly prescribed to reduce swelling and inflammation caused by injury or disease such as arthritis. Some NSAIDs, such as ponstan (mefenamic acid) and naproxen, help ease menstrual cramps and reduce menstrual blood loss.
A recent study published in The British Medical Journal, looked at 10 million people, aged 77 on average, who took NSAIDs, and compared them with those who did not. The researchers, from University of Milano-Bicocca in Italy, found taking NSAIDs increased the risk of being taken to hospital with heart failure by 19%.
Experts say that it has been known for some time now that NSAIDs ought to be used with caution in patients with, or who are at significant risk of, heart disease. However, this risk of heart failure applies only to those who take these pain-killers on a very regular basis rather than in those to take them occasionally. Since heart disease and joint problems often co-exist in the elderly, the study serves as a reminder that one ought to be more careful with using NSAIDs as a means of pain control. It also serves to remind doctors to prescribe them, only if required, at the lowest effective dose, and for the shortest possible time.
Young people who take short courses of NSAIDs need not worry. However, having to take pain killers regularly, should raise some concerns over potential side effects, and should be discussed with a doctor.
What About Cox-2 Inhibitors?
Selective Cox-2 inhibitors are a type of NSAID that directly targets cyclooxygenase-2 (COX-2), an enzyme responsible for inflammation and pain. Selective targeting of COX-2 reduces the risk of peptic ulceration, a known side effect of prolonged use of the less selective NSAIDs. After several COX-2 inhibiting drugs were approved for marketing (eg. Vioxx, Celebrex, Arcoxia), data from clinical trials revealed that they caused a significant increase in heart attacks and strokes, with some drugs in the class having worse risks than others. Rofecoxib (Vioxx) was taken off the market in 2004 because this whilst the other Cox-2 inhibitors received boxed warnings on their labels.
An review of the cardiovascular risk of NSAIDs by Farkouh and Greenberg found that ibuprofen is associated with a cardiovascular risk similar to that of celecoxib (a Cox-2 inhibitor). Interestingly, studies found that naproxen was not associated with an increased cardiovascular risk in patients with preexisting cardiovascular disease when compared to other NSAIDs and Cox-2 inhibitors. Naproxen has thus been determined to be the preferred nonselective NSAID for patients with high cardiovascular risk.
Source: Medscape.com
Further Reading
The article above is meant to provide general information and does not replace a doctor's consultation.
Please see your doctor for professional advice.