Below are two articles that evaluate the risk of heart disease for various NSAIDS. Since heart disease is associated with a high level of use of these painkillers, and because those of us with RA often use them daily, this information is relevant for us.
Note the conclusion: the safest NSAID for heart disease is Aleve (naproxen sodium). Note also the extremely high rate of problems with diclofenac (Voltaren).
No one really thinks much about popping a nonsteroidal anti-inflammatory drug (NSAID) for minor complaints, but we should. A 9-year study finds that certain pain relievers can increase cardiovascular risk, even in healthy people. The study was based on detailed registry data of more than 1 million NSAID users. The average age was 39 years.
Researchers looked at several different types of NSAIDs. Here are the results:
* Ibuprofen — 29% greater risk for fatal or nonfatal stroke;
* Rofecoxib — 66% increased risk for cardiovascular death. (Remember the high rate of heart attack and stoke is why it was taken off the US market back in 2004.);
* Diclofenac — 91% increased risk for cardiovascular death. (Diclofenac has high COX-2 inhibition selectivity.);
* Celecoxib — findings inconclusive. The number of events was too small but available data did seem to show a trend for increased cardiovascular risk; and
* Naproxen — NOT associated with any increased cardiac risk.
That’s why these researchers say naproxen is the safest choice for your heart.”>
Common Painkillers Linked to Increased Risk of Heart Problems
The drugs include traditional non-steroidal anti-inflammatory drugs (NSAIDS) as well as new generation anti-inflammatory drugs, known as COX-2 inhibitors.
… researchers say that doctors and patients need to be aware that prescription of any anti-inflammatory drug needs to take cardiovascular risk into account.
NSAIDs have been the cornerstone of managing pain in patients with osteoarthritis and other painful conditions. In 2004, the COX-2 inhibitor rofecoxib was withdrawn from the market after a trial found that the drug increased the risk of cardiovascular disease. Since then, there has been much debate about the cardiovascular safety of COX-2 inhibitors and traditional NSAIDs, which several studies have not been able to resolve.
So researchers in Switzerland performed a comprehensive analysis of all randomised controlled trials comparing any NSAID with other NSAIDs or placebo.
They included 31 trials and 116,429 patients taking seven different drugs (naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib, lumiracoxib) or placebo to provide a more reliable estimate of the cardiovascular risks of these drugs than previous studies.
Overall, the number of harmful outcomes that could be compared for placebo versus treatment was low. In 29 trials there was a total of 554 heart attacks; in 26 trials there were 377 strokes, and in 28 trials there were 676 deaths. So the absolute risk of cardiovascular problems among people taking painkillers was low, but the researchers did find that, relative to placebo, the drugs carried important risks.
For instance, compared with placebo, rofecoxib and lumiracoxib were associated with twice the risk of heart attack, while ibuprofen was associated with more than three times the risk of stroke. Etoricoxib and diclofenac were associated with the highest (around four times) risk of cardiovascular death.
Naproxen (Aleve) appeared least harmful in terms of cardiovascular safety among the seven analysed preparations.
Although the number of cardiovascular events in the trials was low, the authors say “our study provides the best available evidence on the safety of this class of drugs.” They conclude: “Although uncertainty remains, little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms. Cardiovascular risk needs to be taken into account when prescribing any non-steroidal anti-inflammatory drug.”
An accompanying editorial says these cardiovascular risks are worrying because many patients have both cardiovascular disease and musculoskeletal disease (arthritis), and suggests that it is time for an evaluation of a broader range of alternatives.