NSAID-Associated Risks for Patients with Heart Disease

Non-steroidal anti-inflammatory drugs (NSAIDs) are more dangerous than previously thought, and should be prescribed with great care among patients with heart disease, according to findings published in the European Heart Journal.

Researchers from Aarhus University in Denmark tested newer, selective COX-2 inhibitors (coxibs) in order to evaluate their gastrointestinal toxicity and anti-inflammatory properties. The researchers added that it has previously been understood that NSAIDs can cause fluid retention and elevate blood pressure in heart disease patients, which could increase the likelihood of a cardiovascular activity. But, they said, the main cause for concern when using these drugs is the risk for gastrointestinal bleeding.

“It’s been well known for a number of years that newer types of NSAIDs increase the risk of heart attacks,” said Morten Schmidt, MD, PhD, in a press release. “For this reason, a number of these newer types of NSAIDs have been taken off the market again. We can now see that some of the older NSAID types, particularly Diclofenac, are also associated with an increased risk of heart attack and apparently to the same extent as several of the types that were taken off the market. This is worrying, because these older types of medicine are frequently used throughout the western world and in many countries available without prescription.”

The study, which was conducted across 14 European universities and hospitals, concluded that NSAIDs should only be sold as over the counter drugs when it has an “adequate warning” about the links and risks to cardiovascular events. Additionally, the study authors added, NSAIDs should not be used in patients who have or at risk for cardiovascular disease.

“Many European countries consume more of these drugs than Denmark,” Schmidt added. Plus, the authors noted that in Denmark, NSAIDs are sold in low doses without a prescription (ibuprofen 200 mg/ tablet) or in higher doses and other types with prescriptions. “But we can still do better and it’s often the case that paracetamol, physiotherapy, mild opioids or other types of NSAIDs with less risk for the heart would be better for the patients. Of course, the recommendations that have been introduced following our study and its review of the heart related risks are a big step in the right direction in relation to patient safety.”