Study: Most Painkillers Up Heart Attack Risk
But Researchers Say Risk Is Minimal for Low Doses of Painkillers
Don't Live in Pain or Fear
So what's a person to do?
"I don't think they should live in pain or live in fear," Singh says. "Increase in the risk of heart attack is a common phenomenon with a large number of NSAIDs and the choice should be made in consultation with a physician."
Singh says these drugs have similar effectiveness and the choice on which painkiller to use should depend on heart and bleeding risks. Another potentially serious side effect of NSAIDs is bleeding stomach ulcers.
Clearly drugs that have high increased risk of heart attack should not be prescribed to patients with risk factors for heart disease, he says.
Painkillers and Stomach Bleeding
On the flip side, drugs that have better stomach safety should be prescribed in patients who have a high risk of stomach bleeding, he says. Cox-2 drugs were originally developed to reduce the risk of stomach bleeding associated with traditional NSAIDs.
"People should discuss alternative treatments with their doctor," Singh says. "For some people, Tylenol (acetaminophen) may be enough, but if they do need an NSAID, they need to determine if it is worth taking the small increase in risk."
Compared with smoking, NSAID use poses a very low risk of heart attack, he points out.
"If a person is at low risk for [heart attacks], this increase can be ignored," says Chris J. Hawkey, MD, co-director of the Institute for Clinical Research and head of the Wolfson Digestive Diseases Center at University Hospital in Nottingham, England.
Hawkey says patients at high risk of stomach bleeding who need an NSAID should ask their doctor about taking a strong acid blocker with their painkiller. These drugs, including Aciphex, Prevacid, Prilosec, and Nexium, help decrease the risk of further stomach problems.
Singh is looking at whether the use of aspirin will cut heart risks seen with these drugs. Aspirin, a blood thinner, is known to decrease risk of heart attack and stroke. "If you take aspirin with these drugs, will that make a difference?" he asks.
In the recent British Medical Journal study,
Patients on NSAIDs, particularly those with known heart disease risk factors, should do what they can to lower the risk of heart attacks. This includes stopping smoking and keeping blood pressure under control, Hawkey says.