New work by researchers in Denmark has shown that non-steroidal anti-inflammatory drugs, or NSAIDs, commonly used around the world to manage pain, could be increasing people's risk of cardiac arrest. The most widely used over-the-counter medications in the world, NSAIDs have been found play a role in platelet aggregation, which can lead to blood clots, causing the constriction of arteries, increasing fluid retention and raising blood pressure. They have been definitively linked to an increased risk of heart failure, and linked to an increase risk of heart attack and stroke. and this study only reinforces the idea that NSAIDs are bad for the heart. The video below summarizes the findings, which were published in European Heart Journal -- Cardiovascular Pharmacotherapy.
"Allowing these drugs to be purchased without a prescription, and without any advice or restrictions, sends a message to the public that they must be safe," explained Gunnar H. Gislason, a Professor of Cardiology at Copenhagen University Hospital Gentofte in Denmark. "Previous studies have shown that NSAIDs are related to increased cardiovascular risk which is a concern because they are widely used."
For this study, the investigators utilized the medical records of 28,947 patients that experienced a cardiac arrest while not in the hospital between the years of 2001 and 2010, who were enrolled in the Danish Cardiac Arrest Registry. The scientists focused on 3,376 patients with cardiac arrest that used prescription NSAID pain relievers, such as diclofenac, naproxen and ibuprofen, as well as the COX-2 selective inhibitors rofecoxib and celecoxib, while over-the-counter medications were not evaluated as part of this study since ibuprofen is the only over-the-counter NSAID that has been approved in Denmark.
They compared patients that used NSAIDs in the 30 days that preceded a cardiac arrest, to the use of NSAIDs in a 30-day period that did not end with cardiac arrest. The work indicated that NSAID use was linked to an increase in the risk of cardiac arrest, by 31 percent. The pain reliever diclofenac was associated with a 50 percent increased risk of cardiac arrest; ibuprofen use had a 31 percent increased risk. Naproxen, celecoxib and rofecoxib use did not correlate to an increased risk of cardiac arrest.
"The findings are a stark reminder that NSAIDs are not harmless," Gislason said. "Diclofenac and ibuprofen, both commonly used drugs, were associated with significantly increased risk of cardiac arrest. NSAIDs should be used with caution and for a valid indication. They should probably be avoided in patients with cardiovascular disease or many cardiovascular risk factors."
Gislason suggested that people should use an abundance of caution when opting for an over-the-counter NSAID pain reliever.
"Over-the-counter NSAIDs should only be available at pharmacies, in limited quantities, and in low doses," Gislason said. "Do not take more than 1,200 mg of ibuprofen per day. Naproxen is probably the safest NSAID and we can take up to 500 mg a day. Diclofenac is the riskiest NSAID and should be avoided by patients with cardiovascular disease and the general population. Safer drugs are available that have similar painkilling effects so there is no reason to use diclofenac."