Common Anti-inflammatory Medications Raise Heart Risk

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Danish researchers have discovered that common use of certain nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with significantly higher risks of dying from heart-related causes among healthy people, according to new research reported in Circulation: Cardiovascular Quality and Outcomes, a journal of the American Heart Association.

"Even though the frequency of these effects is quite low, they are still important," said Emil Loldrup Fosbøl, M.D., study author and research fellow in the Department of Cardiology at Gentofte University Hospital in Hellerup, Denmark. "People should at a minimum be aware that this is a problem."

The American Heart Association and the U.S. Food and Drug Administration already warn people with heart disease to be cautious about taking NSAIDs, which include ibuprofen (brand named Advil, Motrin) and diclofenac.

The new study is the first to show the same kind of increased risk among people without cardiac problems.

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"Very few studies have been designed to answer the important question: Do NSAIDs also increase the cardiovascular risk among healthy people who use these drugs for minor complaints?" said lead author Dr. Emil L. Fosbol, a cardiologist at Gentofte University Hospital in Hellerup. "This study is the first to confirm that the cardiovascular risk is indeed increased when healthy individuals use some of the drugs."

"These findings are completely consistent with what we have found in patients with cardiovascular disease," Dr. Michael E. Farkouh, a clinical cardiologist at Mount Sinai Cardiovascular Institute in New York City, said of the Danish study. "Drugs that elevate blood pressure and are associated with a thrombotic [artery-blocking] effect can be harmful in patients who are otherwise healthy."

The percentage increases in the study were large, but the absolute overall risk in otherwise healthy people was small, Farkouh said. Nevertheless, "before you take any medication, you should consult with a physician, particularly these medications," he said.

That warning applies especially to people who exercise regularly and are thus more likely to take an NSAID for muscle and joint pain, Farkouh said. Regular use of an NSAID increases the risk not only of cardiovascular problems but also of bleeding, a known side effect of the medications, he said.

In fact, the Danish study found an increased incidence of major bleeding events, some fatal, from all NSAIDs except celecoxib (Celebrex). Celecoxib did not appear to raise the risk of coronary death or stroke either.

Elliott M. Antman, M.D., lead author of the statement and professor of medicine at Harvard Medical School and Brigham and Women's Hospital in Boston stated, "I find this new study reassuring because it endorses the recommendations we made using a large body of actual clinical evidence.”

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