Arthritis Health Center

Like Vioxx, Ibuprofen May Up Heart Attack Risk

June 9, 2005 -- Ibuprofen, naproxen, and similar pain relievers raise a person's risk of heart attack, a new study suggests.

Ibuprofen and naproxen - traditional anti-inflammatory pain relievers -- have been considered more heart friendly than the new Cox-2 type of pain drugs. Two of the Cox-2 drugs, Vioxx and Bextra, have been pulled from the market Vioxx and Bextra, have been pulled from the market because they increase a person's risk of heart attack.

The new study, led by Julia Hippisley-Cox, MD, MRCP, of the University of Nottingham, England, did show that Vioxx increased the risk of heart attack by 32% when taken in the previous three months. But it also linked ibuprofen -- brand names include Advil and Motrin -- to a 24% higher risk of heart attack compared with people who had not taken any anti-inflammatory in the last three years.

Diclofenac (brand names including Arthrotec, Cataflam, and Voltaren) increased heart attack risk by 55%. Naproxen (brand names include Aleve) was also linked to a higher heart attack risk, although the finding was not as strong.

Previous research has shown no link between occasional use of painkillers and heart attacks. Patients taking over-the-counter anti-inflammatory painkillers should not take them for more than 10 days without checking with their doctor.

A second study by Canadian arthritis specialist Marie Hudson, MD, MPH, found that among elderly patients who already had heart disease, Celebrex -- a Cox-2 drug still on the market -- was safer than Vioxx and possibly even traditional anti-inflammatory drugs.

Both studies appear in the June 11 issue of the British Medical Journal.

Heart Attacks and Pain Pills

Hippisley-Cox and colleague Carol Coupland analyzed data collected from general practices across England, Wales, and Scotland. They analyzed data from 9,218 people with first-time heart attacks and compared them to 86,349 matched patients without heart attacks.

Those with heart attacks were much more likely to have used anti-inflammatory painkillers regularly, also known as nonsteroidal anti-inflammatory drugs (NSAIDs).

"The list of traditional NSAIDs seems to be comparable to the Cox-2 drugs in increasing heart attack risk," says Hippisley-Cox, "but when you put that into perspective, the vast majority of people taking these drugs will not be harmed by them."

Older patients are at the highest risk of heart attack and thus more vulnerable to the increased heart risk from pain drugs. Hippisley-Cox calculates that Vioxx would cause one extra heart attack for every 700 patients aged 65 and older taking the drug. Ibuprofen would cause one extra heart attack for every 1,000 patients taking the drug.

Pain vs. Side Effects

"Patients are taking painkillers because they are in pain," Hippisley-Cox says. "At the end of the day, we need to know the benefits and the risks. A young patient with arthritis has a low risk, so a 30% increase on that is quite small -- whereas that person's dreadful pain is very likely to affect quality of life. So there is a trade-off of living without pain vs. the risk of side effects. The message to the consumer is not to panic and not to change treatment based on these study findings."