Ibuprofen link to heart attack risk

By Celia Hall, Medical Editor, Expat Telegraph

(Filed: 10/06/2005)

Painkillers, including ibuprofen, can significantly increase the risk of having a heart attack, researchers say today.

Their study, which looks at non-steroidal anti-inflammatory drugs (NSAIDS) follows similar concerns over another group of drugs called Cox2 inhibitors.

These have been widely used to relieve the pain of arthritis and have been found to cause an increased risk of heart attacks and stroke.

In the latest study, researchers from Nottingham University identified more than 9,000 men and women who had suffered first heart attacks and looked at their medication in the preceding four years. They looked at whether these patients had been prescribed NSAIDs, including ibuprofen, diclofenac, naproxen, celecoxib (Celebrex) and rofecoxib (Vioxx). Ibuprofen was the only over-the-counter drug studied.

The worst risks were with diclofenac, a prescription painkiller, which increased the risk by 55 per cent.

The increased risk of a heart attack for those taking rofecoxib was 32 per cent. For ibuprofen it was 24 per cent and for celecoxib 21 per cent.

Julia Hippisley-Cox, the professor of clinical epidemiology and general practice at Nottingham, said this meant for those over 65 taking diclofenac that one extra patient for every 521 would have a heart attack linked to the drug. For those who had taken rofecoxib the figure was one patient at risk for every 695 taking the drug and for ibuprofen the figure was one for every 1,005 patients.

Prof Hippisley-Cox said yesterday that the study, in the British Medical Journal, had not included aspirin. Aspirin is not normally given in high doses to relieve chronic pain because of the risk of causing stomach bleeding. "This was an observational study and not a trial and I don't not think patients should stop taking their drugs. But it does suggest that we should be looking carefully at the use of NSAIDs," she said.

A spokesman for the Medicines and Healthcare products Regulatory Agency said it was taking part in a European-wide review of the safety of traditional NSAIDs and would be examining the study. He added: "In the meantime, prescribers should note existing advice regarding the use of anti-inflammatory medicines, in particular that the lowest effective dose should be used for the shortest period of time necessary.

"Ibuprofen has an excellent safety record which is why it has been made available as an over-the-counter medicine. There are a number of epidemiological studies regarding the cardiovascular safety of ibuprofen.

"The new study has limitations as identified by the authors and needs to be viewed in the context of a number of other studies which have not shown an increased risk with ibuprofen."

Last year the drug company Merck withdrew Vioxx (rofecoxib) from the market and this year Pfizer said it was looking again at the data on Celebrex (celecoxib).

A spokesman for Pfizer said the study appeared to be consistent with other larger studies showing that Celebrex at approved doses safely and effectively treated arthritis patients with chronic inflammatory pain. "For many patients, Celebrex can provide pain relief that is not achieved with alternative therapies such as NSAIDs which cannot be easily used for long periods due to increases in side effects," he added.

Neil Betteridge, the chief executive of Arthritis Care, expressed concern about the findings and advised anxious patients to seek the advice of their doctors. He added: "This is further depressing news for people with arthritis. "Recent months have seen doubts raised over a number of drugs used to help people manage their arthritis."

© Copyright of Telegraph Group Limited 2005.

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