"It's been well-known for a number of years that newer types of NSAIDs - what are known as COX-2 inhibitors, increase the risk of heart attacks. For this reason, a number of these newer types of NSAIDs have been taken off the market again. We can now see that some of the older NSAID types, particularly Diclofenac, are also associated with an increased risk of heart attack and apparently to the same extent as several of the types that were taken off the market," says Morten Schmidt, MD and PhD from Aarhus University, who is in charge of the research project. He adds: "This is worrying, because these older types of medicine are frequently used throughout the western world and in many countries available without prescription."
Each year, more than 15 per cent of the western countries collects a prescription for NSAIDs. This figure increases with age. Sixty per cent of the adult population in Denmark collects at least one prescription for an NSAID within a ten-year period. Heart patients are no exception and previous studies have shown that up to forty per cent of Danish patients with heart failure or previous heart attacks are prescribed NSAIDs.
The study, which was carried out in collaboration between 14 European universities and hospitals, including a number of leading European heart specialists, is today being published in the most prestigious European journal of heart medicine, European Heart Journal.
New guidelines
In the study, the researchers have gathered all research on the use of NSAIDs in patients with heart disease. The survey means that the European Society of Cardiology has now for the first time formulated a number of recommendations about what doctors should consider before prescribing painkillers to their patients.
"When doctors issue prescriptions for NSAIDs, they must in each individual case carry out a thorough assessment of the risk of heart complications and bleeding. NSAIDs should only be sold over the counter when it comes with an adequate warning about the associated cardiovascular risks. In general, NSAIDs are not be used in patients who have or are at high-risk of cardiovascular diseases," says another of the authors, Professor in cardiology Christian Torp-Pedersen, Aalborg University, Denmark.
Consumption should be reduced even more
For a number of years, Danish researchers have made significant contributions in the field. One result of this work has been a reduction in the use of Diclofenac in Denmark. However, according to Morten Schmidt, there is still room for improvement: "Many European countries consume more of these drugs than Denmark. But we can still do better and it's often the case that paracetamol, physiotherapy, mild opioids or other types of NSAIDs with less risk for the heart would be better for the patients. Of course, the recommendations that have been introduced following our study and its review of the heart-related risks are a big step in the right direction in relation to patient safety," says Morten Schmidt.
FACTS about arthritis medicine (NSAID):
- NSAIDs is an abbreviation for Nonsteroidal Anti-Inflammatory Drugs and is used to treat a wide range of diseases, in particular disorders in the muscular and bone system, where the drug counteracts swelling, pain and limitations in movement associated with inflammation.
- NSAIDs are not antibiotics and therefore do not help to fight infections caused by bacteria.
- NSAIDs are in Denmark sold both in low doses (Ibuprofen 200 mg/tablet) without a prescription and in higher doses and other types with a prescription.
Morten Schmidt, Morten Lamberts, Anne-Marie Schjerning Olsen, Emil Fosbøll, Alexander Niessner, Juan Tamargo, Giuseppe Rosano, Stefan Agewall, Juan Carlos Kaski, Keld Kjeldsen, Basil S. Lewis, Christian Torp-Pedersen
Cardiovascular safety of non-aspirin non-steroidal anti-inflammatory drugs: review and position paper by the working group for Cardiovascular Pharmacotherapy of the European Society of Cardiology
European Heart Journal, DOI: http://dx.doi.org/10.1093/eurheartj/ehv505