Like Vioxx, Ibuprofen May Up Heart Attack Risk
Study: 'Traditional' Painkillers May Carry Small but Serious Risk
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Pain vs. Side Effects
"Patients are taking painkillers because they are in pain," Hippisley-Cox says. "At the end of the day, we need to know the benefits and the risks. A young patient with arthritis has a low risk, so a 30% increase on that is quite small -- whereas that person's dreadful pain is very likely to affect quality of life. So there is a trade-off of living without pain vs. the risk of side effects. The message to the consumer is not to panic and not to change treatment based on these study findings."
Interestingly, low-dose aspirin did not change a person's risk. Other studies have suggested that low-dose aspirin may offer some protection against the heart risks associated with pain drugs.
"The study suggests that the effects of NSAIDs are present whether or not patients are being prescribed aspirin," Hippisley-Cox says. "Aspirin does not cancel the risk out."
The British researcher is quick to note that her study does not prove anything. While it is a carefully done study, its findings are still preliminary. Only a well-designed clinical trial that randomly assigns patients to take one treatment compared to another can substantiate the findings.
Celebrex a Better Choice?
In a smaller observational study, Hudson and colleagues looked at data on more than 2,200 patients aged 66 and over with congestive heart failure. All the patients needed a pain reliever.
"We know that in these patients, traditional NSAIDs and Cox-2 drugs are not generally indicated," Hudson tells WebMD. "But the fact is that some of these patients still need these drugs. For those who need them, we wanted to see if there are some that are better or worse than others."
The bottom line: Risk of death and recurrent heart failure appeared slightly lower in patients taking Celebrex.
"I am telling my patients who have heart failure and arthritis that the first-line treatment is still acetaminophen [Tylenol]," Hudson says. "But this does not always offer relief. So if I have to go on to [another] drug, I explain the increased risks. If I have to choose, I have been prescribing Celebrex."
The Hippisley-Cox and Hudson studies did not receive funding from drug companies. Neither of the researchers reports financial connections with the makers of any of the drugs under study.