Using common anti-inflammatory painkillers is linked to an increased risk of heart failure, according to research published in the British Medical Journal (but see our expert analysis below).
The study, at the University of Milano-Bicocca in Italy, found that non-selective non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and diclofenac increase the risk of being admitted to hospital.
The researchers analysed data from almost 10 million regular NSAID users (the drugs are commonly taken by arthritis patients) who started treatment between 2000 and 2010. During this time there were 92,163 hospital admissions for heart failure in the study group.
They found that patients who took any NSAID in the two weeks prior to admission were 19 per cent more likely to have heart failure, compared with people who had used NSAIDs at any other point in the past.
Heart failure risk increased in patients taking seven drugs: diclofenac, ibuprofen, indomethacin, ketorolac, naproxen, nimesulide, piroxicam, etoricoxib and rofecoxib.
In particular, taking diclofenac and indomethacin at very high doses is associated with a doubled risk. Previous studies have linked NSAIDs to abnormal heart rhythm and an increased risk of stroke.
Professor Peter Weissberg, medical director at the British Heart Foundation, said: ‘This large observational study reinforces previous research showing that some NSAIDs, a group of drugs commonly taken by patients with joint problems, increase the risk of developing heart failure. It has been known for some years now that such drugs need to be used with caution in patients with, or at high risk of, heart disease. This applies mostly to those who take them on a daily basis rather than only occasionally.
‘Since heart and joint problems often co-exist, particularly in the elderly, this study serves as a reminder to doctors to consider carefully how they prescribe NSAIDs, and to patients that they should only take the lowest effective dose for the shortest possible time. They should discuss their treatment with their GP if they have any concerns.’
This study certainly gives us food for thought in the use of NSAIDs in older patients (it is important to note that the average age in the study was 77). However, regular/prolonged use of these drugs has long been considered risky for other reasons, such as potential gastric side effects and problems with kidney function, and more recently cardiovascular concerns have been raised.
It is generally considered that these drugs should be used more sparingly than, say, paracetamol, particularly in older patients who are at greater risk of harm from regular use. One of the biggest obstacles clinically is the fact that, from an efficacy standpoint, they are excellent drugs. They tend to work well, and as a result of this patients like them and often don’t want to stop taking them, because they are improving their quality of life.
What we need to do, as we should be doing with all drugs, is to weigh up the risks and benefits of using them and make shared, informed and individual decisions with our patients as to what to do, ensuring that they only take medication they need, at the lowest effective dose, for the shortest time possible.
Research score: 3/5