Arthritis Health Center

Study: Most Painkillers Up Heart Attack Risk

Painkillers and Stomach Bleeding

On the flip side, drugs that have better stomach safety should be prescribed in patients who have a high risk of stomach bleeding, he says. Cox-2 drugs were originally developed to reduce the risk of stomach bleeding associated with traditional NSAIDs.

"People should discuss alternative treatments with their doctor," Singh says. "For some people, Tylenol (acetaminophen) may be enough, but if they do need an NSAID, they need to determine if it is worth taking the small increase in risk."

Compared with smoking, NSAID use poses a very low risk of heart attack, he points out.

"If a person is at low risk for [heart attacks], this increase can be ignored," says Chris J. Hawkey, MD, co-director of the Institute for Clinical Research and head of the Wolfson Digestive Diseases Center at University Hospital in Nottingham, England.

Hawkey says patients at high risk of stomach bleeding who need an NSAID should ask their doctor about taking a strong acid blocker with their painkiller. These drugs, including Aciphex, Prevacid, Prilosec, and Nexium, help decrease the risk of further stomach problems.

Singh is looking at whether the use of aspirin will cut heart risks seen with these drugs. Aspirin, a blood thinner, is known to decrease risk of heart attack and stroke. "If you take aspirin with these drugs, will that make a difference?" he asks.

In the recent British Medical Journal study, aspirin did not affect the risk of heart disease.aspirin did not affect the risk of heart disease.

Patients on NSAIDs, particularly those with known heart disease risk factors, should do what they can to lower the risk of heart attacks. This includes stopping smoking and keeping blood pressure under control, Hawkey says.