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Certain Painkillers May Raise Odds of Stroke, Heart Attack: Study
Date:7/14/2011

THURSDAY, July 14 (HealthDay News) -- Heart disease patients with high blood pressure who take a class of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs) are at greater risk for heart attack, stroke or even death, new research shows.

NSAIDS include popular medications such as such as aspirin, Celebrex, ibuprofen (Advil, Motrin) and naproxen (Aleve). The results are published in the July issue of The American Journal of Medicine.

"Among coronary artery disease patients with hypertension, chronic self-reported use of NSAIDs was associated with harmful outcomes, and this practice should be avoided where possible," Dr. Anthony A. Bavry, assistant professor in the division of cardiovascular medicine at the University of Florida, Gainesville, said in a journal news release.

In conducting the study, Bavry and colleagues followed 882 long-term NSAID users and almost 22,000 people who used NSAIDs intermittently over an average of about three years.

Patients with high blood pressure and coronary artery disease who took NSAIDs regularly had a 47 percent increase in the rate of death as well as nonfatal heart attack and stroke. After a period of five years, those rates jumped to 126 percent for death and 66 percent for heart attack, the investigators found.

Because there's a lack of data to help researchers understand why people with heart disease and high blood pressure who take NSAIDs are at greater risk for adverse events, the study authors suggested that these patients should consider alternative methods of pain relief until more research is done.

Commenting on the findings, Dr. Howard S. Weintraub, clinical director of the Center for the Prevention of Cardiovascular Disease and clinical associate professor of medicine at NYU Langone Medical Center in New York City, noted that the new study had several strengths.

"It is taken from a large group of patients with coronary artery disease in a generally older population," he said. "But the findings seem to cast more concern about the safety of NSAID's in higher risk patients. It is notable that the risk increased with higher blood pressure."

Still, he added, "one of the concerns about incriminating NSAID's is that the use of certain [cholesterol-lowering] drugs such as statins was lower in the chronic-use group. Hence, their [heart] risk could be expected to be higher. We are also not able to distinguish risk within the class."

"Once again it sounds like it is the length of use or perhaps more accurately the cumulative exposure to this class [that is driving the risk]. This would suggest that more occasional use could be okay," according to Weintraub.

Adding his perspective, Dr. Victor Khabie, co-chief of the Orthopedics and Spine Institute at Northern Westchester Hospital in New York, said that, "as an orthopedic sports medicine specialist I see a lot of baby boomers who use NSAIDs to ease their joint pain with sports. Perhaps acetaminophen or topical agents . . . should be considered in these individuals. Sports medicine specialists should be aware of the potential risk NSAIDs cause in this patient population and counsel their patients appropriately."

More information

The U.S. National Library of Medicine has more on pain relievers.

-- Mary Elizabeth Dallas

SOURCE: The American Journal of Medicine, news release, July 12, 2011; Howard S. Weintraub, M.D., clinical director, Center for the Prevention of Cardiovascular Disease and clinical associate professor, medicine, NYU Langone Medical Center, New York City; Victor Khabie, M.D., co-chief, Orthopedics and Spine Institute, Northern Westchester Hospital, Mt. Kisco, N.Y.


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