Increased Risk of Heart Failure Possibly due to NSAID Pain Killers

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Public Health Watchdog Breaking News
Public Health Watchdog Breaking News

Prescription-strength ibuprofen, naproxen and other popular pain relievers are known as non-steroidal anti-inflammatory drugs (NSAIDs). Researchers report that these drugs might raise an individual’s relative risk of heart failure by almost 20 percent. This figure is based on analysis of medical records for nearly 10 million patients.

The study author, Andrea Arfe, a PhD student at University of Milano-Bicocca, in Italy said that risk increases proportionately with the amount of NSAIDs a person is taking. The risk of hospitalization for heart failure doubles as some NSAIDs used at very high doses include idlofena (Cataflam or Voltaren), etoricoxib (Arcoxia), indomethacin (Indocin) and piroxicam (Feldene), Arfe said.

Although the study focused only on prescription NSAIDs, the findings might also apply to over-the-counter NSAIDs as well. “Although over-the-counter NSAIDs are normally used at lower doses, they are sometimes available at the same doses as prescription NSAIDs and may be inappropriately overused,” Arte said.

The results were reported September 28 in the British Medical Journal. NSAIDs decrease inflammation and pain by blocking an enzyme called cyclooxygenase. This comes in 2 forms, COX-1 and COX-2. COX-1 protects the stomach lining from digestive acids, while COX-2 is produced by inflamed or injured joints.

NSAIDs, such as aspirin or ibuprofen block the action of both COX-1 and COX-2, the reason some people suffer with upset stomachs after taking them. Newer NSAIDs such as celecoxib (Celebrex) target only COX-2, and are called COX-2 inhibitors, MedlinePlus reports.

Dr. Christopher O’Connor, editor-in-chief of a cardiology journal JACC: Heart Failure, said that NSAIDs cause sodium retention, which leads to some reduction in kidney function so they might play a role in heart failure.

Millions of European health records were pored over by Arte and her colleagues from 1999 through 2010. The patients came from Germany, Italy, the Netherlands, and the United Kingdom. The analysis had a total of 27 individual NSAIDs, including 23 traditional NSAIDs and 4 selective COX-2 inhibitors, reports MedlinePlus.

More than 92,000 hospital admissions were identified for heart failure, and the researchers matched those patients against 8.2 million patients without such histories. The conclusion was that people who had been prescribed an NSAID within the two weeks prior had a 19 percent increased risk of hospital admission for heart failure, according to MedlinePlus.

The traditional NSAIDs that increase risk of heart failure are diclofenac, ibuprofen (Motrin), indomethacin, ketorolac (Toradol), naproxen (Aleve or Midol), nimesulife, and piroxicam. The two COX-2 inhibitors are etoricoxib and rofecoxib, neither of which is approved for use in the United States.