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Ibuprofen, Other NSAIDs Raise Stroke and Heart Attack Risk


The next time you take ibuprofen or other NSAIDs (nonsteroidal anti-inflammatory drugs) to relieve a headache or arthritis pain, you may be increasing your risk for stroke and heart attack. A British Medical Journal study reports that use of NSAIDs raise stroke and heart attack risk by as much as fourfold.

Common NSAIDs good for pain but not the heart

The findings of the new study are the result of an analysis of 31 randomized controlled trials that involved 116,429 patients. Compared with placebo, use of ibuprofen was associated with more than a threefold risk of stroke. Ibuprofen is available both over-the-counter (e.g., Advil, Motrin, PediaCare, others) and by prescription. General instructions for ibuprofen use include the warning to not take the drug for more than 10 days without a doctor’s directions.

The study also reported that the newer generation NSAIDs rofecoxib (Vioxx) and lumiracoxib (Prexige), known as COX-2 inhibitors, were associated with a twofold risk of heart attack, and the COX-2 inhibitor etoricoxib (Arcoxia) and traditional NSAID diclofenac (Rufenal) were associated with a fourfold risk of cardiovascular death.

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This study was not the first time cardiovascular risks have been associated with the use of COX-2 inhibitors and traditional NSAIDs. Rofecoxib was withdrawn from the market in 2004 after it was found to increase the risk of cardiovascular disease, as was another COX-2 inhibitor, valdecoxib (Bextra), which was withdrawn in 2005 for the same reason.

A study that evaluated more than 1 million people and published in Circulation, Cardiovascular Quality and Outcomes reported that rofecoxib and diclofenac were associated with an increased risk of cardiovascular death, and that ibuprofen showed a trend for increased risk of stroke. On a positive note, a recent study found that ibuprofen use may reduce the risk of developing Parkinson’s disease.

Given that many patients are taking ibuprofen and other NSAIDS for pain and also using medications for cardiovascular disease such as stroke and heart disease, the authors of the new study emphasize that “cardiovascular risk needs to be taken into account when prescribing any non-steroidal anti-inflammatory drug.”

Fosbol EL et al. Circulation, Cardiovascular Quality and Outcomes 2010 Jul; 3(4): 395-405
Trelle S et al. British Medical Journal 2011; 342:c7086