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NSAIDs, Especially Diclofenac, Raise Second Heart Attack Risk


If you have suffered a first heart attack, avoid using NSAIDs (nonsteroidal anti-inflammatory drugs), especially diclofenac (Voltaren). Results of a study that followed more than 83,000 people found that NSAIDs use following a heart attack significantly increased the risk of a second heart attack or death within one week of taking the drugs.

Avoid taking NSAIDs after a heart attack

NSAIDs are among the most popular and affordable drugs on the market, available via both over-the-counter and by prescription, for treatment of various types of pain and inflammation. Ibuprofen, diclofenac, and other NSAIDs work by blocking the enzymes (cyclooxygenase [COX]) that produce prostaglandins, substances that promote pain, inflammation, and fever.

Over the past decade, studies have shown an increased risk of cardiovascular events associated with the use of NSAIDs, enough so that two COX-2 inhibitors, rofecoxib and valdecoxib, were removed from the market. Now in a new study, Anne-Marie Schjerning Olsen, MB, a research fellow at Copenhagen University, warns that “Our results indicate that there is no apparent safe therapeutic window for NSAIDs in patients with prior heart attack.”

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The study involved a review of 83,675 adults in Denmark who had experienced their first heart attack between 1997 and 2006. Nearly half (42%) of the survivors had been prescribed at least one NSAID, with ibuprofen being the most often prescribed (23% of cases), followed by diclofenac (13.4%), celecoxib (4.8%), and rofecoxib (4.7%; now recalled).

Overall, use of NSAIDs was associated with a 45 percent greater risk of death or a second heart attack within a week of treatment. Within three months of taking NSAIDs, the risk rose to 55 percent. People who took diclofenac were at greatest risk, as they were three times more likely to have a second heart attack or to die within one week of using NSAIDs.

Use of diclofenac poses other dangers, including an increased risk of serious gastrointestinal problems such as perforation or bleeding. These events can occur without warning and be fatal. The Food and Drug Administration has also issued a warning stating that people who undergo heart bypass surgery should not use diclofenac during the time surrounding surgery, and another warning concerning an increased risk of liver problems, including jaundice and liver failure.

For now, one NSAID that has not been shown to increase the risk of a second heart attack or death is naproxen. Otherwise, Elliott Antman, MD, an author of a 2007 American Heart Association NSAIDs advisory, noted that the findings of this latest study “confirm our prior practical advice that NSAID use should be avoided and if unavoidable should be used at the smallest doses for the shortest time possible.”

Food and Drug Administration
Olsen AS et al. Circulation 2011 May 9 online; doi: 10.1161/CIRCULATIONAHA.110.004671