Study: Most Painkillers Up Heart Attack Risk
But Researchers Say Risk Is Minimal for Low Doses of Painkillers
June 15, 2005 -- A new study shows that most prescription and over-the-counter painkillers increase the risk of heart attacks.
In the wake of the largest study to date showing most nonsteroidal anti-inflammatory drugs (NSAIDs) -- including ibuprofen, naproxen, and Celebrex -- increase the risk of heart attacks in people with arthritis, experts are once again urging all involved to weigh their individual risks when choosing a painkiller.
"This is a class effect of all the drugs," researcher Gurkirpal Singh, MD, professor of medicine, immunology, and rheumatology at Stanford University Medical School in Palo Alto, Calif., tells WebMD. Singh's study was presented at the Annual European Congress of Rheumatology in Vienna, Austria.
But the study shows the risk is minimal at lower doses.
This controversy over painkillers and heart attacks first focused on drugs like Vioxx, Bextra, and Celebrex -- so called Cox-2 drugs. But Singh points out that even traditional anti-inflammatory painkillers carry this heart risk.
"All the hysteria was over the Cox-2 drugs, and we are saying that it's not just Cox-2 ... drugs that are doing it. It could occur with any NSAID." He says that some of the older, traditional NSAIDs are associated with the highest heart risk.
Last April, the FDA issued new label warnings for all anti-inflammatory painkillers -- prescription and over the counter.
Prescription painkillers will now carry "black box" alerts warning of heart disease and stroke risk. Over-the-counter brands -- usually taken at lower doses and for a shorter amount of time -- must alter their labels to include more risk information. At the same time, the FDA stressed that there was no increased risk from short-term use of over-the-counter painkillers. They recommend checking with your doctor if you need over-the-counter painkillers for more than 10 days.
Aspirin is not included in the warnings as there is strong evidence that it can help prevent heart disease. Acetaminophen (Tylenol) is not an anti-inflammatory drug and also is not included in the warnings.
Drugs With the Highest Risk
Indomethacin (Indocin) and sulindac (Clinoril) -- both traditional NSAIDs -- had the highest risk in the new study. Indomethacin increased heart risk by 71% and sulindac by 41%.