Taking ibuprofen could quickly increase the risk of heart attack – a “worrying” potential side-effect that appears to occur from the first week of regular use, according to a new study.
While the overall risk of heart attack remains low, they are most likely to occur within the first month of taking a high dose of ibuprofen or other common painkillers, an international team of researchers has claimed.
Ibuprofen, available in supermarkets and corner shops, is a type of non-steroidal anti-inflammatory drug (NSAID).
“Taking any dose of NSAIDs for one week, one month, or more than a month was associated with an increased risk of myocardial infarction [heart attack],” wrote the researchers, led by Michèle Bally of the University of Montreal Hospital Research Centre in Canada.
“Prescribers should consider weighing the risks and benefits of NSAIDs before instituting treatment, particularly for higher doses.”
The study, published in the British Medical Journal, analysed data from almost 450,000 people, 61,460 of whom had suffered a heart attack.
Researchers examined the effect over time of taking three common anti-inflammatory painkillers – ibuprofen, diclofenac and naproxen – and two others, called celecoxib and rofecoxib.
The increased risk of suffering a heart attack was between 24 per cent and 58 per cent overall when taking the drugs, compared with not using them.
In context, these jumps are small, as the average likelihood of heart attack among those taking NSAIDs is around one per cent a year, with patients who already have heart disease or related conditions such as diabetes at greater risk.
But Dr Bally told The Independent even small increases in heart attack risk are important from a public health viewpoint because the use of these medicines is so widespread.
“If an individual’s risk of heart attack is one per cent and it increases to 1.25 per cent, they don’t care,” she said. “But at a population level, it’s important, and if people want to contribute to public health, they might wish to make more informed choices.”
Using the drugs for longer than one month did not increase risk more than with shorter use, found the researchers, from Canada, Germany and Finland.
They studied people who took both a low dose of the drugs or a high dose, defined by the researchers as over 1200mg, or three maximum-strength tablets, of ibuprofen each day. For diclofenac, this was over 100mg and for naproxen, over 750g.
“This large-scale study worryingly highlights just how quickly you become at risk of having a heart attack after starting NSAIDs,” said Dr Mike Knapton, associate medical director of the British Heart Foundation.
Dr Knapton said it was already known that these drugs increase the risk of having a heart attack, adding: “Whether you are being prescribed painkillers like ibuprofen, or buying them over the counter, people must be made aware of the risk and alternative medication should be considered where appropriate.”
Naproxen is available over the counter for period pain and on prescription for conditions such as arthritis and back pain. Diclofenac was available over the counter in the UK until 2015, but is now only available on prescription.
In 2013, researchers said one year's high-dose treatment with ibuprofen and diclofenac, used by hundreds of thousands of arthritis sufferers in the UK, leads to three avoidable heart attacks and one fatal heart attack for every 1,000 users.
A spokesperson for the National Institute of Health and Care Excellence said all prescribing guidance was regularly reviewed and would take into consideration all evidence that comes to light between reviews.
Sales of over-the-counter painkillers amounted to almost £600 million in the UK in 2015.
“This study builds on research highlighting the risks involved in using NSAIDs, such as ibuprofen, to treat pain – and it’s important that as new research is published, it is taken on board to inform the clinical guidelines that support our work,” said Professor Helen Stokes-Lampard, Chair of the Royal College of GPs.
“This study should also raise awareness amongst patients who self-medicate with NSAIDs that are available over the counter, to treat their pain.
“Actually, the use of NSAIDs in general practice to treat patients with chronic pain is reducing and some of the drugs in this study are no longer routinely prescribed in the UK, such as coxibs, as we know that long term use can lead to serious side effects for some patients.”
Professor Jane Mitchell, Head of Cardiothoracic Pharmacology at Imperial College London, said: “This is an observational study so it cannot say whether these painkillers actually cause heart attacks, but it does give more information about an association we knew about from previous studies.
“We do not know what the potential underlying mechanism could be, but other research has suggested it might involve these drugs blocking a hormone in the body called prostacyclin which protects our blood vessels, protects the kidney and thins the blood.
“But we need more research to know whether this is indeed the case – finding the mechanisms is vital so that we can devise tests that can identify those people at greatest risk of heart attacks so that the majority patients can take their medication with relative confidence.”
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