Do painkillers cause heart attacks?

The latest research from Canada has found that regular use of even small amounts of over-the-counter painkillers can rapidly increase the risk of heart attack, but local experts suggest that the benefits can outweigh the risks in many cases.

Published in The BMJ, the research looked at the associated risk of acute myocardial infarction, in real-life circumstances, from the use of commonly prescribed non-steroidal anti-inflammatory drugs (NSAIDs) such as rofecoxib, ibuprofen, diclofenac, celecoxib and naproxen.

The team, led by Michèle Bally of the University of Montreal Hospital Research Center (CRCHUM), conducted meta-analysis of nearly half a million individuals in relevant studies from Canada, Finland and the United Kingdom. Of the collective 446,763 people studied, 61,460 had suffered a heart attack. The researchers found that the risk of heart attack increased after just one week of using any dose of NSAIDs. Higher doses and prolonged usage saw the risk increase by between 20 and 50%.

The researchers concluded: “Given that the onset of risk of acute myocardial infarction 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.”

Professor John McNeil from Monash University School of Public Health & Preventive Medicine said: “These results add to a series of previous studies suggesting that NSAIDs increase the risk of myocardial infarction. However, these drugs can provide substantial relief to many patients with various types of pain and the trade-off against a relatively small risk of heart disease may well be worth taking. The longstanding advice to take the lowest effective dose for the shortest time is sound, especially in those whose risk of heart disease is already high.”

Professor Greg Dusting from the University of Melbourne added: “There is basic science evidence that could suggest that these drugs, many of which are freely available as over-the-counter medications even in supermarkets, could present a problem in some patients with concurrent cardiac risk factors, but the clinical and epidemiological evidence is crucial here (about the pharmacological type of NSAID, the dose and duration of treatment or NSAID consumption, as well as the medical status of the subjects in which the trials have been done).”

A more holistic response was provided by Monash University Emeritus Professor Mark Wahlqvist, who is also a Visiting Professor at the National Health Research Institute (NHRI) in Taiwan and Zhejiang University in China. He said, “Seen in a broader context, these findings signal an imperative to seek wellbeing, health and longevity from low-risk anti-inflammatory options such as regular movement in public open space and dietary diversity. Research has shown just how extensive and complementary the anti-inflammatory properties of diverse foods are and their use offers a high benefit-to-risk ratio. They are affordable and can be provided sustainably.”

Image credit: ©stock.adobe.com/au/Shakzu