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Painkillers Can Harm Heart Attack Patients!
 

Certain groups of painkillers, known as non-steroidal anti-inflammatory drugs (NSAIDs), are considered quite safe for most people when used occasionally in low to moderate doses to relieve pain and inflammation. These drugs, including aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve), as well as prescription arthritis drugs known as COX-2 inhibitors, are available over the counter in most countries.

Excessive use of NSAIDs can, however, lead to ulcer perforation, upper gastrointestinal bleeding, and even death. The safety of NSAIDs for people with heart disease has also been questioned, with the exception of aspirin. COX-2 inhibitors were linked to increased risks of heart attack and other cardiovascular problems. Such findings had caused Rofecoxib (Vioxx) and Valdecoxib being removed from the market in 2004 and 2005, though Celecoxib (Celebrex) is still prescribed.

A recent study reported that NSAIDs are considered risky for patients who have had a heart attack, and the risks would not go away even 5 years later.

Researchers from Copenhagen University Hospital Gentofte and other Danish Institutes studied 99,187 patients aged 30 years or older admitted with first-time heart attack between 1997 and 2009. They found that those who used the NSAIDs afterward were more likely to have a repeat heart attack or die over the next 5 years. Their paper was published online on September 10, 2012 in ‘Circulation’, an American Heart Association (AHA) journal.

Based on pharmacy records, 43,608 of all the patients studied (44 percent) were prescribed with NSAIDs at some point after the heart attack. The risk of death from any cause for those receiving an NSAID was 59 percent higher 1 year after their heart attack, and 63 percent higher after 5 years. Meanwhile, the risk of having another heart attack or dying from coronary artery disease was 30 percent higher 1 year later and 41 percent higher after 5 years.

In absolute terms, 20 percent of NSAID users died in the first year after the heart attack, versus about 12 percent of non-users. Over the next 4 years, mortality rates in both groups declined. During year 5, 9.5 percent of NSAID users died compared to 6 percent of non-users.
The findings took into account of other illnesses and medication use in the patients and differences in age, sex, income and years of hospitalization.

The study only indicated an association between NSAIDs and heart attack risks, and it did not prove cause and effect on its own. Nevertheless, there are numerous studies have now consistently revealed similar findings. Yet no study so far can possibly find out why NSAIDs cause problems for heart attack survivors and other people with cardiovascular disease.

One possible reason is that people who take an NSAID stop taking aspirin, a drug that is also classified as NSAID. Aspirin makes platelets less sticky and less likely form blood clots, which in narrowed arteries are the major cause of heart attacks.

Meanwhile, NSAIDs are certainly toxic to the kidneys and they might affect blood clotting, blood vessel function and blood pressure, which all can contribute to the overall risk of mortality.

However, the researchers could not possibly know why and the exact dose people in the study were using NSAIDs. The study also did not establish a threshold effect, which specified the maximum dosage a patient might be able to take the drugs without any increased risks.

There have not been specific guidelines for the use of NSAIDs. But since 2007, AHA has advised people with heart disease to first try acetaminophen (marketed as Tylenol) or aspirin when they need pain relief. If that cannot relieve the pain, an NSAID might be required but must be at a low dose and for a short time only.

Although NSAIDs are available over the counter, it does not mean that they are absolutely safe to just buy and take. People who had heart attack before or have heart failure, advanced liver disease or high blood pressure are advised to consult their doctors before getting any of these pain relievers.

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