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Older Women: Some Painkillers May Raise Heart Risk

Class of drugs that includes naproxen linked to increased chance of heart attack, stroke, but finding not conclusive

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The study is published in the July issue of Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

In the study, NSAIDs were sorted into three categories: those that selectively inhibit cox-2, those that appear to inhibit cox-2 more than cox-1, and those that appear to inhibit cox-1 more than cox-2.

The researchers then reviewed medical data for more than 160,000 postmenopausal women enrolled in the Women's Health Initiative, a set of clinical trials launched in 1991 to test the effects of hormone therapy. The trials required women to report use of prescription and nonprescription medications.

Within this group of women, naproxen was the most widely used NSAID that inhibited cox-2 more than cox-1, while ibuprofen (Advil, Motrin) was the most widely used NSAID that inhibited cox-1 more than cox-2.

"Although there are other agents that are in this analysis, our findings are largely applied to naproxen and ibuprofen since they were such a wide part of our study sample," Bavry said.

The doctors found a moderately increased risk of heart attack and stroke associated with use of both selective cox-2 inhibitors and those NSAIDs that affect cox-2 more than cox-1. Use of NSAIDS that inhibit cox-1, including ibuprofen, appeared to have no effect at all on heart attack or stroke risk.

Women should discuss this research with their doctor to decide whether naproxen is right for them, Bavry said.

"Many people think that naproxen is the safer NSAID," he said. "This study is counter to our previous understanding of these agents, and signals to me that we need to further research these agents for safely treating chronic pain syndromes in women."

Antman agreed that everyone should talk with their doctor if they regularly use NSAIDs.

"Please inform your physician about all medications you take, even over-the-counter medications, and do not routinely use NSAIDs for an extended period of time," he said.

But people should be careful drawing conclusions from this latest finding, Antman added. The study was not a randomized trial, he noted, and the available data left some important questions unanswered.

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