why do nsaids increase heart attack risk

Commonly prescribed painkillers increase the likelihood of having a within the first month of taking them if consumed in high doses, a study suggests. All five nonsteroidal anti-inflammatory drugs ( ) examined could raise the risk as early as the first week of use, an international team of researchers found. They concluded that there was a greater than 90% probability that all the NSAIDs they studied were associated with a heightened risk of heart attack. The overall odds of having a heart attack were about 20% to 50% greater if using NSAIDs compared with not using the drugs, although it varied for the individual drugs assessed, which also included naproxen, celecoxib and rofecoxib. As it was an observational study, cause and effect could not be established conclusively. Nevertheless the authors, led by MichцЕle Bally of the University of Montreal Hospital Research Centre, write: БGiven that the onset of risk of acute myocardial infarction [heart attack) occurred in the first week and appeared greatest in the first month of treatment with higher doses, prescribers should consider weighing the risks and benefits of NSAIDs before instituting treatment, particularly for higher doses. Б
Previous studies had suggested but the authors said the timing, the effect of dose, the treatment duration and the comparative risk between different types were poorly understood. For, published in the BMJ on Tuesday, the researchers analysed results on 446,763 people on healthcare databases in countries including Canada, Finland and the UK, of whom 61,460 had a heart attack.


The results suggested that the risk of heart attack associated with NSAID use was greatest with higher doses and during the first month of use. With longer treatment duration, risk did not seem to continue to increase but as the researchers did not study repeat heart attacks, they advised that it remains prudent to use NSAIDs for as short a time as possible. They said the potential increase in risk was 75% for ibuprofen and naproxen and more than 100% for rofecoxib but that uncertainty about the extent of the increased risk was greatest for ibuprofen and naproxen. Dr Mike Knapton, an associate medical director at the, said the study Бworryingly highlights just how quickly you become at risk of having a heart attack after starting NSAIDsБ. БWhether you are being prescribed painkillers like ibuprofen, or buying them over the counter, people must be made aware of the risk and alternative medication should be considered where appropriate,Б he said. But the lack of absolute risks of heart attack Б for people using NSAIDs and those who are not Б in the paper, and the fact that the researchers were unable to exclude other possible influencing factors, led some independent commentators to conclude that it was difficult to assess its significance.


Stephen Evans, a professor of pharmacoepidemiology at the London School of Hygiene and Tropical Medicine, said it was Бgood quality, observational researchБ, but added: БThis study suggests that even a few daysБ use is associated with an increased risk, but it may not be as clear as the authors suggest. The two main issues here are that the risks are relatively small, and for most people who are not at high risk of a heart attack, these findings have minimal implications. Б He advised that it offered Бno reason to induce anxiety in most users of these drugsБ. Prof Helen Stokes-Lampard, the chair of the Royal College of GPs, said: БThese drugs can be effective in providing short-term pain relief for some patients Б what is important is that any decision to prescribe is based on a patientБs individual circumstances and medical history, and is regularly reviewed. Б About 190,000 people a year go to hospital due to heart attacks in the UK, according to the British Heart Foundation. When headache or back pain strikes, many of us turn to ibuprofen for some quick relief. A new study, however, finds that using this and other classes of nonsteroidal anti-inflammatory drugs for as little as 1 week may increase the risk of heart attack. Study leader MichГЕle Bally, of the University of Montreal Hospital Research Center in Canada, and colleagues recently reported their findings in The BMJ. According to the Centers for Disease Control and Prevention (CDC), every year, around in the United States have a, otherwise known as myocardial infarction.


A number of studies have suggested that the use of certain nonsteroidal anti-inflammatory drugs ( ) may increase the risk of heart attack. So strong is this evidence that, in 2015, the U. S. Food and Drug Administration (FDA) about the risk of heart attack with the use of over-the-counter and prescription NSAIDs. However, Bally and colleagues note that previous studies looking at the risk of heart attack with NSAID use have been subject to various limitations, such as small sample sizes and lack of comparisons with a. As a result, the team says that these studies have failed to generate a solid understanding of which NSAID doses pose the greatest risk or how the length of use may impact heart attack risk. With the aim of closing this research gap, the team reviewed 82 studies that looked at the incidence of heart attack with NSAID use. After screening the studies for eligibility, the researchers were left with eight studies that included a total of 446,763 men and women from Canada, Finland, and the United Kingdom. Of these individuals, 61,460 had experienced a heart attack. The researchers looked at the NSAID use of each participant, focusing on specific types, including ibuprofen, diclofenac, celecoxib, rofecoxib, and naproxen.


Overall, the team found that individuals who used any of these NSAIDs at any dose for at least 1 week had a, compared with individuals who did not use NSAIDs. Looking at heart attack risk by individual NSAID use, the researchers identified a possible 100 percent increased risk with rofecoxib, and a possible 75 percent increased risk for both ibuprofen and naproxen. The team uncovered evidence that suggests the first month of NSAID use poses the highest risk of heart attack, particularly if the drugs are taken at high doses. The researchers note that their study is purely observational, so it is unable to make any conclusions about cause and effect between NSAID use and risk of heart attack. That said, they say that the type of analysis they conducted allowed them to conclude with 90 percent certainty that the use of NSAIDs raises the risk of heart attack. In summary, compared with non-use of NSAIDs in the preceding year, we documented that current use of all studied NSAIDs, including naproxen, was associated with an increased risk of acute myocardial infarction. Given that the onset of risk of acute myocardial infarction occurred in the first week and appeared greatest in the first month of treatment with higher doses, prescribers should consider weighing the risks and benefits of NSAIDs before instituting treatment, particularly for higher doses. ".

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