Two common painkillers used worldwide, ibuprofen and diclofenac, can increase the risk of heart disease if taken in high doses, according to new research.
The study shows that for every thousand patients taking the drugs, the number of preventable deaths from heart disease each year is increased by a factor of three, as a result of the painkillers.
Ibuprofen is sold over the counter frequently in the US, and is named on the World Health Organization’s list of essential medicines necessary to meet the minimum needs for a healthcare system.
Diclofenac is less popular in the US, but it’s by far the most widely used drug of this class – non-steroid anti-inflammatory drugs (NAIDs) – in the world.
“It’s been known for several years of a risk between these non-steroidal agents and heart disease, but this really does emphasize concerns that have been had about these medications,” says Dr. Jeffrey Alexis, a cardiologist at the University of Rochester Medical Center in Western New York.
He says the biggest impact of this study will hopefully be more conversation about risk factors between doctors and patients before these types of painkillers are prescribed.
Long-term use of anti-inflammatory painkillers like ibuprofen taken in high doses is usually linked to chronic pain management.
People with arthritis often take these painkillers in standard daily doses high enough to increase the risk of heart problems.
And, the study shows the popular drugs are just as likely to cause heart disease as discredited painkiller Vioxx, which was withdrawn from the market in 2004 after similar research was released.
Alexis says it’s unlikely these drugs will meet a similar fate.
“The problem is that these drugs can be very effective for pain management, so I’m not clear that this data will lead to drugs being withdrawn from the market.”
Alexis says patients need to weigh up the risk factors with quality of life issues when making decisions about long-term use of the painkillers.
The study, published in the Lancet journal, shows the risk is greater for people taking high doses who also have existing heart conditions, smoke, are overweight, or live with cardiac risks like high blood pressure or cholesterol.
The report investigated more than 350,000 patient records from more than 600 separate clinical trials to gain the most comprehensive data on the risks of NSAIDs, published to date.
The study looked at high-dose prescription levels of the drugs instead of over -the-counter levels. And, Alexis says people who use the painkillers for the occasional headache or weekend hangover have no real reason to worry.
But, he says there does need to be more research done on the impacts of low doses of this class of painkiller.
“When you start seeing an effect with higher doses you have some concern, could it be occurring at lower doses as well. So I would have some concern, and certainly we need more data to be able to understand that better.”