Commonly used analgesics increase the risk of heart problems by a fifth, the largest study of its kind has found.

Doctors have been urged to review the treatment of patients taking non-steroidal anti-inflammatory drugs long term and choose other options for those at risk of heart problems, according to researchers of a study published in the BMJ. Occasional use of the drugs for aches and pains is unlikely to be a problem.

However, John Smith, PAGB chief executive, sounded a note of caution over the research. “This observational study analysed prescription-only NSAIDs, used long-term by people with an average age of 77 years to treat conditions such as arthritis,” he commented. “Prescribed NSAIDs contain a higher dosage than medicines available over-the-counter (OTC), which the authors acknowledge would typically be used by younger people, at lower doses and for shorter durations than those prescribed.

“The authors admit that the study has several limitations. The study does not provide data on absolute risk, therefore the probability of these people developing heart failure without the use of NSAIDs is unknown.

“The authors also highlight that the risk of hospital admissions varies between the type of NSAID used and the dose taken. Furthermore, heart failure is often associated with other cardiovascular diseases which could mean that some of the people analysed were already at higher risk of heart failure prior to the study.”

Link well established

Consultant cardiovascular pharmacist and Royal Pharmaceutical Society spokesperson Helen Williams added: “The link between use of NSAIDs and increased risk of heart failure is well-established. This paper helps to quantify the risk with individual NSAID agents and assess the impact of dose regimen.

“Over recent years, the NHS has moved away from more the potent NSAIDs, such as indomethacin, piroxicam, and even diclofenac because of the established increased risk of heart attacks and strokes with these agents. This study indicates that current use of these agents, particularly at higher doses, is also associated with a higher risk of admission to hospital due to heart failure, regardless of having a prior heart failure diagnosis and independent of gender.

“In this study, current use of ibuprofen or naproxen, was associated with a lower overall risk of hospitalisation due to heart failure compared to these more potent agents, indicating they may be a more suitable option for routine clinical use, which is reassuring as they are the preferred agents in most NHS organisations. Only current use of celecoxib was associated with no increased risk of hospitalisation due to heart failure.

“The study reinforces the need to carefully weigh up the risks and benefits of NSAID therapy, utilising agents with a lower risk of CV events overall including heart failure, minimising the prescribed dose to that required to give adequate symptom relief and, where possible, limiting the duration of therapy to minimise exposure.”