The research, published Tuesday in the American Heart Assn.'s journal, Circulation, suggests that for patients who have suffered a heart attack, even short-term use of NSAIDs, or nonsteroidal anti-inflammatory drugs for headaches, back pain or sore muscles and joints is a bad idea.
Research in the last seven years has linked regular use of NSAIDs to an increased risk of heart attacks and strokes. In the process, cardiologists and primary care physicians have been warned that patients with established cardiovascular disease should avoid taking NSAIDs for long periods of time, but suggest that brief or episodic use is probably safe.
The latest study establishes that despite safety concerns about this class of drugs for such patients, the medications are used by many in the wake of a heart attack. Of 83,677 Danish heart attack patients followed in the study, 42.3% received NSAIDs from Danish pharmacies, which keep records that allowed researchers to piece together each patient's medication history. In all, 35,257 of those patients had a repeat heart attack or died.
Among the widely used pain relievers, researchers found the risk of heart attack or death rose immediately three- to fourfold with the use of diclofenac, an arthritis medication sold under the commercial names Voltaren and Cataflam, and continued to be elevated--although less dramatically than in week one, for 14 weeks of use. The risk of death or repeat heart attack showed deven steeper increases with the use of celecoxib (commercially marketed as Celebrex) and Rofecoxib (marketed as Vioxx until September 2004 when its maker voluntarily withdrew the drug from the worldwide market). But those risks peaked in weeks four and six of use, respectively.
Ibuprofen --sold under such commercial names as Motrin and Advil--proved the safest of the NSAIDs, but did elevate the risk of death or a repeat heart attack slightly, peaking in week six. Naproxen (marketed as Naprosyn and Aleve) also was associated with a slight rise in death or heart attack risk, but the peak in that risk came in the first week of use.
"Our results indicate that there is no apparent safe therapeutic window for NSAIDs in patients with prior myocardial infarction, and challenge the current recommendations of short-term use of NSAIDs as being safe," the authors write.