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Painkillers Up Post-Heart Attack Death

Study Shows High Doses Are Particularly Deadly
By
WebMD Health News
Reviewed by Louise Chang, MD

Nov. 14, 2005 (Dallas) -- Taking anti-inflammatory drugs, especially at high doses, can be deadly for people who have had a heart attack, a new study shows.

The new study, looking at people who take anti-inflammatory drugs after suffering their first heart attack, shows that the painkillers may be dangerous for people with existing heart disease.

"The finding is consistent with all the other evidence showing that anti-inflammatory drugs [can be bad for the heart]," says Sidney C. Smith Jr., MD, professor of medicine at the University of North Carolina at Chapel Hill, who was not involved with the new study.

"People who have had a heart attack and have been prescribed NSAIDs should talk to their doctor so they can weigh the risks and benefits of the drugs and talk about alternative treatments," Smith tells WebMD.

Researcher Gunnar H. Gislason, MD, a research fellow at Bispebjerg University Hospital in Copenhagen, Denmark, agrees.

"If you can avoid them, it makes sense to switch to another type of medication if you have cardiovascular disease," he tells WebMD. "But if you need to take them, use low doses."

High Doses of Vioxx, Celebrex Particularly Deadly

For the study, presented at the American Heart Association's Scientific Sessions 2005, researchers examined the medical records of 58,432 men and women discharged from the hospital from 1995 to 2002 after a first heart attack. Then, using a national prescription database, they looked at their use of NSAIDs and their dosages.

More than 40% of the people had used at least one NSAID, and nearly 10% had used one of the so-called Cox-2 drugs Celebrex or Vioxx.

Study participants who took high doses of a Cox-2 drug (more than 200 milligrams a day of Celebrex or 25 milligrams a day of Vioxx) were about four to five times more likely to die over the study period, compared with those not taking any anti-inflammatory drugs, the study showed.

People who took more than 1,200 milligrams a day of ibuprofen were nearly twice as likely to die as those who didn't take painkillers. High doses of diclofenac, another traditional NSAID, more than tripled the risk of death.

Lower doses of Celebrex and Vioxx also raised their risk of dying by about twofold. But lower doses of ibuprofen were associated with decreased risk.

The researchers found no increased risk for recurrent heart attack in patients receiving Cox-2 drugs or the other anti-inflammatory medications studied.

The researchers are now looking at participants' hospital records and causes to figure out why high doses are so deadly.

"We found that hospital readmissions for heart failure are two to three times higher in people on Celebrex and Vioxx and about 50% higher in people taking ibuprofen after a heart attack, so that may play a role," Gislason says. "But it could be that a lot of these people are having second heart attacks and dying before they ever reach the hospital."

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