If you regularly take pain killers – even those available over the counter – you often expose yourself to higher risks of heart attack and apoplexy. This is the result of a meta-analysis of 31 clinical studies.
The most commonly used pain killers are non-steroidal anti-inflammatory drugs. They dull pain, lower fever and inhibit inflammations, but they also have some undesirable side effects and risks. These side effects have been re-evaluated by a research group at the University of Bern’s. For the extensive network meta-analysis, the scientists used results from 31 clinical studies including data on seven different pain killers and 116,429 patients. The researchers conclude that some non-steroidal anti-inflammatory drugs increase the risk of heart attack and apoplexy considerably. «Due to their often underestimated cardiovascular risks, this class of pain killers should be used with caution,» says Sven Trelle, author of the study.
Up to four times higher cardiovascular mortality
The researchers analysed the side effects of Naproxen, Ibuprofen, Diclofenac, Celecoxib, Etoricoxib, Rofecoxib and Lumiracoxib. These drugs are commonly used to manage musculoskeletal pains of elderly patients who often also have cardiovascular problems. Without drugs, an average of 1% of these patients die per year. All analysed drugs are associated with a heightened risk of heart attack and apoplexy. The highest risk comes with the conventional over-the-counter drug Diclofenac and the COX-2 inhibitor Etoricoxib which was admitted to the Swiss market last year. In comparison to a placebo, the two drugs displayed a cardiovascular mortality rate that was four times higher.
Naproxen offers the most favourable risk profile. This drug is, however, associated with considerable gastrointestinal side effects which often negatively affect its therapeutic uses.
Both traditional as well as the newer so-called COX-2 selective pain killers (they only inhibit one of the enzymes involved in the inflammatory reaction and should theoretically act more specifically) raise cardiovascular mortality. «This shows,» says Trelle, «that different molecular properties do not always lead to different side effects.»
To be used with caution
«Our results do not allow any inferences regarding the side effects of drugs that we didn’t analyse,» says Peter Jüni, responsable of the study. The only reason they did not extend their study to cover other non-steroidal anti-inflammatory drugs is the lack of reliable data relating to cardiovascular safety of other substances. «The lack of such data should not lead to the conclusion that other pain killers have no side effects,» Jüni warns. «All drugs of this class should be used with caution in patients with musculoskeletal pains.»