Arthritis Health Center

Study: Most Painkillers Up Heart Attack Risk

Drugs With the Highest Risk

Indomethacin (Indocin) and sulindac (Clinoril) -- both traditional NSAIDs -- had the highest risk in the new study. Indomethacin increased heart risk by 71% and sulindac by 41%.

Mobic upped risk of heart attack by 37%, while the recently pulled Cox-2 drug Vioxx increased risk by 32%, the study showed. Ibuprofen (Advil, Motrin) increased risk by 11%. Celebrex -- the sole Cox-2 drug still on the market in the U.S. -- increased risk of heart attack by 9%. The study did point out one NSAID, Relafen, that was not associated with an increased risk of heart attacks.

In a study released last week in the British Medical Journal, ibuprofen was associated with a 24% higher risk of heart attack.ibuprofen was associated with a 24% higher risk of heart attack.

In the new study, people who took Bextra had no increased risk of heart attack. Bextra was recently removedBextra was recently removed from the market during the FDA's sweeping review of anti-inflammatory drugs.

"From what I understand, this drug was pulled mainly due to skin reactions rather than [heart] risk," Singh says. Bextra has been associated with a potentially fatal skin disease called Stevens-Johnson syndrome.

Risk increased with escalating doses of all the NSAIDs. The higher the dose, the greater the risk, the study showed.

Little Risk With Lower Doses

Little to no risk was seen with lower doses of NSAIDs.

• There was a 2% risk of heart attack with 150 milligrams a day or less of diclofenac (Arthrotec, Cataflam, Voltaren). That rose to a 37% increase in heart attack risk with doses over 150 milligrams a day.
• A 7% increase in heart attacks with 1,000 milligrams a day or less of naproxen (Aleve, Anaprox, Naprosyn) rose slightly to a 16% risk with more than 1,000 milligrams a day.
• Celebrex was associated with a 1% increase with 200 milligrams a day or less but a 24% increase with higher doses.

As a whole, all traditional NSAIDs slightly raised the risk of heart attack by about 12%. Compared with traditional NSAIDs, the only Cox-2 drug to raise heart risk was Vioxx. The new findings are based on data from Medi-Cal, California's Medicaid program, and included all adult arthritis patients treated with an NSAID between 1999 and 2004. Of this population, more than 15,000 had a heart attack.

Don't Live in Pain or Fear

So what's a person to do?

"I don't think they should live in pain or live in fear," Singh says. "Increase in the risk of heart attack is a common phenomenon with a large number of NSAIDs and the choice should be made in consultation with a physician."

Singh says these drugs have similar effectiveness and the choice on which painkiller to use should depend on heart and bleeding risks. Another potentially serious side effect of NSAIDs is bleeding stomach ulcers.

Clearly drugs that have high increased risk of heart attack should not be prescribed to patients with risk factors for heart disease, he says.