Jan. 12, 2011 -- A new study weighs in on the debate over the relative safety of nonsteroidal anti-inflammatory medications (NSAIDs), commonly used to treat joint and muscle aches and pain.
The study, published online in the BMJ, concludes that NSAIDs significantly increase the risk of cardiovascular events in patients who take them regularly.
“These drugs have some use in the treatment of chronic pain,” says Peter Jüni, MD, head of the division of clinical epidemiology at The University of Bern in Switzerland. “But they have safety issues. In the signals we saw, there was a two- to fourfold increase in the risk of myocardial infarctions [heart attacks], stroke, or cardiovascular death, and these are, clinically, considerable increases in risk.”
For example, Jüni says his review found that only 25 to 50 patients would need to be treated with NSAIDs for one year to cause one additional event such as a heart attack or stroke.
Given that millions of people take these drugs, and that many of them are seniors -- members of a group already likely to have other risk factors for heart disease -- that relatively small number needed to harm, as epidemiologists call it, is alarming to doctors.
“There’s a very large overlap between cardiovascular risk and the musculoskeletal symptoms that people take NSAIDs for,” says Wayne A. Ray, PhD, director of the division of pharmacoepidemiology in the department of preventive medicine at Vanderbilt University in Nashville.
A 2002 analysis of the government’s National Health and Nutrition Examination Survey, for example, found that 40% of adults with osteoarthritis, or OA, also had high blood pressure, while 32% percent had high total cholesterol. Twenty percent of people with OA reported that they smoked.
“You have an 80-year-old person with a history of heart disease who has a problem with her knees. This is someone who’s at cardiovascular risk and likely to be taking NSAIDs,” says Wayne, who wrote an editorial that accompanied the study.
Many doctors already exercise caution when considering NSAIDs for the relief of chronic pain because these drugs are also known to increase the risk of ulcers and serious bleeding in the stomach and gastrointestinal tract.
It wasn’t until relatively recently, after a study found that the painkiller Vioxx was associated with significant increases in the risks of heart attacks and strokes, that doctors started to wonder if other drugs in this class might have heart risks, too. Vioxx was taken off the market in 2004.
“We found, almost inadvertently, that these drugs can have cardiovascular effects. We were sort of caught without sufficient knowledge base to guide clinical practices,” Ray says.
“There are differences in the various NSAIDs and these differences might well confer differences in cardiovascular risk. We really have less information than we need about the comparative safety of these drugs,” he says.