Common painkillers are more dangerous than we think

Many Danes are prescribed NSAIDs for the treatment of painful conditions, fever and inflammation. But the treatment also comes with side effects, including the risk of ulcers and increased blood pressure. A major new study now gathers all research in the area. This shows that arthritis medicine is particularly dangerous for heart patients, and also that older types of arthritis medicine, which have not previously been in focus, also appear to be dangerous for the heart.

"It's been well-known for a number of years that newer types of NSAIDs - what are known as COX-2 inhibitors, increase the risk of heart attacks. For this reason, a number of these newer types of NSAIDs have been taken off the market again. We can now see that some of the older NSAID types, particularly Diclofenac, are also associated with an increased risk of heart attack and apparently to the same extent as several of the types that were taken off the market," says Morten Schmidt, MD and PhD from Aarhus University, who is in charge of the research project. He adds:

"This is worrying, because these older types of medicine are frequently used throughout the western world and in many countries available without prescription."

Each year, more than 15 per cent of the western countries collects a prescription for NSAIDs. This figure increases with age. Sixty per cent of the adult population in Denmark collects at least one prescription for an NSAID within a ten-year period. Heart patients are no exception and previous studies have shown that up to forty per cent of Danish patients with heart failure or previous heart attacks are prescribed NSAIDs.

The study, which was carried out in collaboration between 14 European universities and hospitals, including a number of leading European heart specialists, is today being published in the most prestigious European journal of heart medicine, European Heart Journal.

New guidelines

In the study, the researchers have gathered all research on the use of NSAIDs in patients with heart disease. The survey means that the European Society of Cardiology has now for the first time formulated a number of recommendations about what doctors should consider before prescribing painkillers to their patients.

"When doctors issue prescriptions for NSAIDs, they must in each individual case carry out a thorough assessment of the risk of heart complications and bleeding. NSAIDs should only be sold over the counter when it comes with an adequate warning about the associated cardiovascular risks. In general, NSAIDs are not be used in patients who have or are at high-risk of cardiovascular diseases," says another of the authors, Professor in cardiology Christian Torp-Pedersen, Aalborg University, Denmark.

Consumption should be reduced even more

For a number of years, Danish researchers have made significant contributions in the field. One result of this work has been a reduction in the use of Diclofenac in Denmark. However, according to Morten Schmidt, there is still room for improvement:

"Many European countries consume more of these drugs than Denmark. But we can still do better and it's often the case that paracetamol, physiotherapy, mild opioids or other types of NSAIDs with less risk for the heart would be better for the patients. Of course, the recommendations that have been introduced following our study and its review of the heart-related risks are a big step in the right direction in relation to patient safety," says Morten Schmidt.

FACTS about arthritis medicine (NSAID):

• NSAIDs is an abbreviation for Nonsteroidal Anti-Inflammatory Drugs and is used to treat a wide range of diseases, in particular disorders in the muscular and bone system, where the drug counteracts swelling, pain and limitations in movement associated with inflammation.
• NSAIDs are not antibiotics and therefore do not help to fight infections caused by bacteria.
• NSAIDs are in Denmark sold both in low doses (Ibuprofen 200 mg/tablet) without a prescription and in higher doses and other types with a prescription.

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Read the scientific article: http://eurheartj.oxfordjournals.org/content/early/2015/09/27/eurheartj.ehv505

MD, PhD Morten Schmidt
Aarhus University and Aarhus University Hospital, Department of Clinical Epidemiology
London School of Hygiene & Tropical Medicine, Non-Communicable Disease Epidemiology
Telephone: (+44) 7469799789
Email: morten.schmidt@clin.au.dk

Christian Torp-Pedersen
Professor of heart medicine and clinical epidemiology
Department of Health Science and Technology, Aalborg University
Telephone: (+45) 9940 3802 / 2445 3790
ctp@hst.aau.dk / ctp@heart.dk