The international team of researchers found that all five non-steroidal anti-inflammatory drugs (NSAIDs) examined could raise the risk as early as the first week of use. They went on to conclude that there was a greater than 90% probability that the NSAIDs studied increased the risk of a heart attack. The overall odds of falling victim to a heart attack were about 20-50% greater if using NSAIDs compared with not using them, although it varied for the individual drugs being assessed, which included naproxen, celecoxib, diclofenac, and rofecoxib. As the study was observational, it was impossible to conclusively establish cause and effect.
Nevertheless, the authors, led by Michèle Bally from the University of Montreal Hospital Research Center, said: “Given that the onset of risk of acute myocardial infarction (heart attack) occurred in the first week and appeared greatest in the first month of treatment with higher doses, prescribers should consider weighing the risks and benefits of NSAIDs before instituting treatment, particularly for higher doses.
For the paper, which was published this month (May 2017), the researchers analyzed results on 446,763 people on healthcare databases in countries including Canada, UK, and Finland, of whom 61,460 had a heart attack.
These results suggest that the risk of heart attacks associated with NSAIDs was greater with higher doses and during the first month of use. With longer usage, risk did not seem to continue to increase but as the researchers did not study repeat heart attacks, they advised that it remains prudent to take NSAIDs for as short a time as possible. They declared that the potential risk increase was around 75% for ibuprofen and naproxen, and more that 100% for rofecoxib.
Dr. Mike Knapton, an associate medical director from the British Heart Foundation, said that this study “worryingly highlights just how quickly you become at risk of having a heart attack after starting NSAIDs.” He goes on to say that “whether you are being prescribed painkillers like ibuprofen, or buying them over the counter, people must be made aware of the risk and alternative medication should be considered where appropriate.”
However, the lack of absolute risks of heart attacks – for people using NSAIDs and those who are not – in the paper, and the fact that the researchers were not able to exclude other possible influencing factors, led some to conclude that it was extremely difficult to assess its significance.
Stephen Evans, a pharmacoepidemiology professor at the London School of Hygiene and Tropical Medicine, declares that it was “good quality, observational research”, but added: “This study suggests that even a few days’ use is associated with an increased risk, but it may not be as clear as the authors suggest. The two main issues here are that the risks are relatively small, and for most people who are not at high risk of a heart attack, these findings have minimal implications.” Therefore, he saw “no reason to induce anxiety in most users or these drugs.”
The chair of the Royal College of GPs, professor Helen Stokes-Lampard, said that “these drugs can be effective in providing short-term pain relief for some patients – what is important is that any decision to prescribe is based on a patient’s individual circumstances and medical history, and is regularly reviewed.”