From Our 2012 Archives
Common Painkillers May Be Risky After Heart Attack
By Salynn Boyles
Reviewed by Louise Chang, MD
Sept. 10, 2012 -- Heart attack survivors who take commonly used pain relievers have a higher risk of dying or having another heart attack, new research shows.
The Danish study adds to the evidence linking non-steroidal anti-inflammatory drugs (NSAIDs) such as celecoxib (Celebrex), diclofenac (Voltaren), ibuprofen (Advil, Motrin), and naproxen (Aleve) to poorer outcomes in heart patients.
Using the painkillers after a first heart attack was linked to a higher risk for a second heart attack or death from any cause. And the risk persisted over at least five years.
Pain Relief Tricky After Heart Attack
Like previous studies, the new research does not prove that NSAIDs are directly responsible for these events.
But the evidence as a whole strongly suggests that the pain relievers should be used cautiously, if at all, by heart attack survivors, says Anne-Marie Schjerning Olsen, MD, who led the Danish study.
"Our results indicate that use of NSAIDs is associated with persistently increased coronary risk, regardless of the time elapsed after a [heart attack]," she says. "Thus, long-term caution is advised in all patients."
The study included data on nearly 100,000 survivors of first heart attacks, taken from Danish hospital and pharmacy registries.
Just under half of the people (44%) filled at least one prescription for an NSAID at some point after their heart attack.
Compared to those who presumably did not take NSAIDs, people who did had a 59% increased risk of death from any cause within one year of having the heart attack and a 63% increased risk over five years.
The risk of having another heart attack or dying from heart disease was 30% higher after one year in NSAID users and 41% after five years.
Even Years Later, NSAIDs May Cause Harm
American Heart Association (AHA) immediate past president Gordon Tomaselli, MD, says the study is one of the first to suggest that NSAID use may be risky for many years after a first heart attack.
Tomaselli directs the division of cardiology at the Johns Hopkins University School of Medicine in Baltimore.
In 2007, the AHA issued a statement on NSAID use in heart patients, urging doctors to carefully weigh the risks vs. benefits before recommending the drugs or prescribing them.
Tomaselli says this means carefully assessing a person's risk, which is influenced by conditions like heart failure or diabetes.
Non-NSAID Painkillers Safer for Some?
He says for many heart patients, non-NSAID painkillers like acetaminophen (Tylenol) or even short-term prescription-narcotic use may be safer pain-relief options.
"Patients who do take NSAIDs should always use the lowest dose possible to control pain for the shortest duration," Tomaselli says. Heart attack survivors should talk to their doctor before regularly using any NSAID, even those available without prescription like ibuprofen or naproxen, he says.
Even though there have been concerns about the safety of NSAID use in heart attack survivors for many years, Schjerning Olsen says most people, and many doctors, are unaware of the potential risk.
"It is important to get the message out to clinicians taking care of patients with cardiovascular disease that NSAIDs are harmful, even several years after a heart attack," she says.
The study appears today in the journal Circulation.
SOURCES: Schjerning Olsen, A.M. Circulation, Sept. 10, 2012. Anne-Marie Schjerning Olsen, MD, research fellow, Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark. Gordon Tomaselli, MD, director, division of cardiology, Johns Hopkins School of Medicine, Baltimore, MD; immediate past president, American Heart Association. News release, American Heart Association.