Commonly used NSAID painkillers such as ibuprofen (sold under the brand name Advil) are associated with increased heart attack risk as early as the first week of use, according to a study published Tuesday.
The increased risk reaches its peak in the first month of use and then levels off, the study found. Higher doses were associated with increased risk. The risk declines after discontinuing the NSAIDs.
While the observational study in BMJ, formerly the British Medical Journal, cannot determine cause and effect, it reinforces previous warnings about potential harm from NSAIDs. Once placed online, the study can be found at j.mp/nsaidmi.
"All NSAIDs, including naproxen, were found to be associated with an increased risk of acute myocardial infarction," the study stated. "Risk of myocardial infarction with celecoxib was comparable to that of traditional NSAIDS and was lower than for rofecoxib."
The warning extends to diclofenac, sold over the counter and prescribed under the brand names of Zipsor, Zorvolex, Voltaren and Cataflam.
"Use for 8-30 days at a high dose was particularly harmful for ibuprofen (>1,200 mg/day), naproxen (>750 mg/day), and rofecoxib (>25 mg/day)," the study stated.
Ibuprofen and naproxen are sold over the counter generically and under the respective brand names of Motrin and Aleve. The prescription drug celecoxib is sold under the brand name Celebrex.
The prescription drug rofecoxib, sold under the brand Vioxx, was taken off the market in 2004 due to cardiovascular risks.
Michèle Bally of the University of Montreal Hospital Research Center led the study. At the time, she was an epidemiology doctoral student at McGill University in Canada.
The higher heart risk from Vioxx may explain why the cardiovascular problems associated with the NSAID class were first discovered in that drug, the study stated.
"Our study suggests a smaller risk of myocardial infarction exists with all other NSAIDs," it said.
Aspirin, technically an NSAID, is the great exception. The granddaddy of painkillers is known to have cardioprotective effects, and has long prescribed for that purpose.
Previous studies have pointed to a heightened risk of heart attack from NSAIDs.
In the new study, Canadian researchers reviewed four other studies in Canada or Europe, performed among the general population or the elderly.
"This patient level meta-analysis of acute myocardial infarction associated with NSAIDs involving 61,460 cases in 446,763 individuals is the largest investigation of its type, and its real world origin helps ensure that findings are broadly generalizable," the study stated.
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