Common pain drugs can increase the risk of heart problems when taken over a long period, with smokers and the obese particularly at risk.
This is according to a new study funded by the UK Medical Research Council and British Heart Foundation and published in The Lancet this week.
It looked specifically at ibuprofen and diclofenac, and found both medicines can slightly increase the risk of heart problems if taken in high doses for a long time.
The study also showed the drugs posed greater risks for smokers and the overweight. The data comes from meta-analyses of 280 trials of non-steroidal anti-inflammatory drugs (NSAIDs) compared to placebo. It also looked at 474 trials of ibuprofen versus diclofenac, both NSAIDs.
The Lancet looked at high-dose prescriptions levels of 150mg diclofenac or 2,400mg ibuprofen each day, ignoring the lower dose OTC versions. These high doses would not be used for common pain relief, but rather for long-term conditions such as arthritis, the researchers point out.
The data shows that for every 1,000 people taking the drugs, there would be three additional heart attacks, four more cases of heart failure and one death as well cases of stomach bleeding, every year as a result of taking these medicines.
So the number of heart attacks would increase from eight per 1,000 people per year normally, to 11 per 1,000 people per year with the drugs.
“Three per thousand per year sounds like it is quite a low risk, but the judgement has to be made by patients,” the lead researcher Professor Colin Baigent told the BBC.
“So if you’re a patient and you go and sit in front of your doctor and discuss it, you are the one who should be making the judgement about whether three per thousand per year is worth it to allow you, potentially, to go about your daily life,” he added.
Naproxen and containing risk
But another drug called naproxen, which has lower risks of heart complications, has started to be regularly prescribed to higher-risk patients by their doctors, given the on-going risks around other medicines.
Professor Alan Silman, medical director of Arthritis Research UK, said in statement: “NSAIDs are a lifeline for many millions of people with arthritis and, when used appropriately, can be extremely effective in relieving pain.
“However, because of their potential side-effects, in particular the increased risk of cardiovascular complications which has been known for a number of years, there is an urgent need to find alternatives that are as effective, but safer.
“GPs are aware of the risks of NSAIDs, and there has been a marked reduction in the use of diclofenac and a switch to naproxen in recent years,” he added.
Some painkillers have already been removed from the market due to an increased risk of cardiovascular events, with the most infamous case being Merck’s Vioxx, which was taken off the market in 2004.
In 2007 the firm paid nearly $5 billion in a settlement for the thousands of people claiming injury after taking its painkiller, which was removed after clinical trial data confirmed it raised the risk of heart attacks and strokes.