Nov. 28, 2005 - Long-term use of two popular over-the-counter pain relievers does not appear to increase a person's risk of having a heart attack, a study from the U.K. shows.
Researchers reported no increase in risk among people who took either ibuprofen or naproxen for a year or longer in moderate doses.
Ibuprofen and naproxen are among the best-selling nonsteroidal anti-inflammatory drugs (NSAIDs). Ibuprofen-based pain relievers include Advil, Motrin, and Nuprin. Naproxen-based products include Aleve and Naprosyn.
A slight, but significant, increase in risk for nonfatal heart attacks was seen among people who took the prescription NSAID diclofenac, known by the brand name Voltaren, for more than a year. Voltaren is one of the most popular pain relievers in Europe, but it is not as widely prescribed in the U.S.
The findings suggest that when it comes to cardiovascular risk, not all NSAIDs are created equal, the study's researcher tells WebMD.
"It appears that there is a small increase in risk for certain NSAIDs under certain circumstances," says Luis A Garcia Rodriguez, MD. "But it is definitely not what we would call a major effect."
It has been just over a year since the popular prescription pain reliever Vioxx was pulled from the market amid concerns about an increase in heart attack and stroke risk among users. The pain reliever Bextra, which is chemically similar to Vioxx, was withdrawn from the market for the same reason in April of this year.
Measuring NSAID Risk
Concerns have been raised about the long-term safety of more traditional anti-inflammatory pain relievers. In an effort to better understand the risks, Garcia Rodriguez and colleague Antonio Gonzalez-Perez of the Spanish Center for Pharmacoepidemiological Research assessed the short- and long-term use of NSAIDs as a class and also looked specifically at three of the most commonly used NSAIDs.
Their findings are published in the Nov. 28 issue of the journal BMC Medicine.
Close to 5,000 heart attack patients and 20,000 people who had not had heart attacks were included in the study.
No increase in heart attack risk was seen among people who took moderate doses of ibuprofen, naproxen, or diclofenac for less than a year.
Although the overall longer use (over a year) of all traditional NSAIDs was associated with a 20% increase in the risk for nonfatal heart attacks, the longer use of ibuprofen specifically appeared to have no impact on risk.
Use of diclofenac demonstrated a small increased risk for heart attack with longer use.
Use of naproxen for longer than a year was associated with a slight decrease in heart attack risk, but it was not clear if the association was real.
"Our study suggests either no effect or a small reduction of cardiovascular risk during sustained treatment with naproxen, a small increased risk with diclofenac, and an undetectable risk with ibuprofen," Garcia Rodriguez and Gonzalez-Perez wrote.
Ask Your Doctor
The new findings may help to allay the fears of regular ibuprofen or naproxen users. But American Heart Association (AHA) spokesman David Herrington, MD, MHS, says patients should still discuss the long-term use of these drugs with their doctor.
The Wake Forest University cardiology professor co-authored a recent AHA advisory on the use of pain medications.
"We said that people should try to use the simplest and safest medications first in the recommended dosages for the shortest possible period of time," he tells WebMD.
For most people that means aspirin or acetaminophen (Tylenol), which have the longest and most well-established safety records, he adds.
Ibuprofen, naproxen, and other NSAIDs should be used for chronic pain under a doctor's supervision by people who can't take aspirin or acetaminophen or by those who do not get adequate pain relief with the drugs, the AHA recommends.
"Every treatment decision is a balance of safety and efficacy, and this is certainly no different," Herrington says. "People shouldn't suffer unnecessarily, but it is important that people who take these drugs long term get guidance from a physician."