Longer-term use of the non-steroidal anti-inflammatory class of painkillers has been found to increase the risk of cardiovascular events such as heart attack and stroke, a new analysis published this week in the British Medical Journal has found.

Researchers from the University of Bern in Switzerland looked at data from 31 clinical trials involving more than 116,000 people taking either naproxen, ibuprofen, diclofenac, Pfizer's Celebrex (celecoxib), Merck's Arcoxia (etoricoxib), Merck's Vioxx (rofecoxib), Novartis' Prexige (lumiracoxib), or a dummy drug.

They found that all the drugs were either associated with a higher risk of stroke, heart attack or cardiovascular death. Compared with placebo, Vioxx (which was taken off the market in 2004 on because of its heart risks) showed the highest risk of heart attack (rate ratio of 2.12), followed by Prexige (2.00). Ibuprofen was associated with the highest risk of stroke (3.36), followed by diclofenac (2.86). Arcoxia (4.07) and diclofenac (3.98) posed the highest risk of cardiovascular death.

NSAIDs remain the standard option for pain management in patients around the globe suffering from painful conditions such as osteoarthritis, and in the US it is estimated that 5% of all visits to the doctor are linked to prescriptions for such painkillers. But a growing body of evidence is fuelling concerns over the safety of this class of drugs, particularly when used in the long-term.

According to the researchers, naproxen seems to be the safest options for patients with osteoarthritis with regard to cardiovascular risk, but they stress that this advantage must be weighed against the gastrointestinal side effects associated with the drug and the need for a parallel prescription for a proton pump inhibitor in many cases. 

The researchers conclude that despite uncertainty over safety "little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms", and they stressed that the CV risk must be taken into account by doctors prescribing any of the NSAID painkillers.

“This confirms what has been known for some years now – taking non-steroidal, anti-inflammatory drugs on a regular basis increases heart attack or stroke risk," said Professor Peter Weissberg, medical director of the British Heart Foundation, commenting on the findings. “However, some patients with debilitating joint pains may consider the small increased risk worthwhile when set against the improvement in their quality of life that these drugs bring," he added.