NEW YORK - All painkillers of
the type known as nonsteroidal anti-inflammatory drugs (NSAIDs) seem to increase
the risk of having a heart attack, according to a population-based study
conducted in Finland.
The finding applies not only to selective COX-2 inhibitors such as celecoxib
but also to non-selective drugs like ibuprofen or naproxen.
"Our results do not support the view that COX-selectivity alone determines
the cardiovascular adverse effects of NSAIDs," lead investigator Dr. Arja
Helin-Salmivaara and colleagues note in the European Heart Journal.
Accumulating data on the cardiovascular risks associated with COX-2
inhibitors have called into question the safety of nonselective NSAIDs, they
note.
The investigators evaluated data for 33,309 heart attack patients entered
into the Finnish Hospital Discharge Register between 2000 and 2003. These
subjects were compared with 138,949 matched "control" subjects.
Helin-Salmivaara from the University of Turku, in Helsinki, and colleagues
found that current use of any type of NSAID was associated with 40 percent
increased risk of having a heart attack.
The risk of having a heart attack tended to decline over time after
discontinuation of NSAID use, but this trend reached statistical significance
only for nonselective NSAIDs.
Still, "even if the risk increase was modest, any risk of serious adverse
events is important at the population level if a drug is not life-saving and is
widely used, as is the case with NSAIDs," the researchers conclude.
In a related editorial, Dr. Deepak L. Bhatt, from Cleveland Clinic Foundation
in Ohio, points out that the report by the Finnish team is the largest
population-based study of NSAIDs performed to date.
Because other studies have yielded different results, and some researchers
have suggested that NSAIDs may actually protect the heart, a large clinical
trial is needed. To that end, Bhatt and his associates have launched a
forward-looking trial to evaluate the safety of celecoxib, ibuprofen and
naproxen among 20,000 patients with arthritis, either with cardiovascular
disease or at high risk.
SOURCE: European Heart Journal, July 2006.
