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Senior Citizens May Have to Bite-the-Bullet for Pain
Relief
Ibuprofen (Advil) and other common painkillers cited
for heart attack risk, particular for older people
 June
10, 2005 Senior citizens may have to bite-the-bullet, when it comes to
surviving pain, just like cowboys did in the old West movies, when the
doctor was about to operate without an anesthetic. There is a new
observational study out today that joins a list of those saying the risk
of heart attack, particularly in older people, increases with the use of
ibuprofen (Advil) and other commonly used painkillers, as well as COX-2
inhibitors.
Patients should not stop taking the drugs
painkillers that are non-steroidal anti-inflammatory drugs (NSAIDS) but
further investigation into these treatments is needed, say the authors
of an article in BMJ.
The most significant findings were for the drugs
ibuprofen, diclofenac and rofecoxib, and their effect on senior
citizens, report the authors. In terms of numbers needed to harm in
the 65 and over age group, for those taking diclofenac, one extra
patient for every 521 patients was likely to suffer a first-time heart
attack. For rofecoxib the figure was one patient for every 695 patients;
and for ibuprofen one patient for every 1005 patients was at risk.
Given the high prevalence of the use of these
drugs in elderly people and the increased risk of heart attack with age,
the relatively large number of patients needed to harm could have
considerable implications for public health, they say.
It is the biggest study of its kind to date. The
researchers identified 9,218 patients across England, Scotland and Wales
who suffered a heart attack for the first time over a four year period.
Patients ranged in age from 25 to 100.
Researchers looked at the prescribing patterns for
these patients, tracking whether and when they had been prescribed
NSAIDS. NSAIDS are commonly prescribed to relieve inflammation and pain,
and include ibuprofen, diclofenac, naproxen, celecoxib and rofecoxib,
plus a host of other less commonly prescribed anti-inflammatories.
The findings were adjusted to allow for several
other heart attack risk factors including age, obesity, and smoking
habits. Importantly, they also adjusted for whether the patient already
suffered from heart disease, or whether they were being prescribed
aspirin.
Researchers found that for those prescribed NSAIDS
in the three months just before the heart attack, the risk increased
compared with those who had not taken these drugs in the previous three
years. For ibuprofen, the risk increased by almost a quarter (24%), and
for diclofenac it rose by over a half (55%).
The newer generation of anti-inflammatories - COX-2
inhibitors - were also associated with increased rates of first-time
heart attack. Those prescribed the drugs in the preceding three months
were at 21% higher risk of heart attack if taking celecoxib, and 32%
increased risk if taking rofecoxib.
Since this study was concluded rofecoxib has
already been withdrawn following concerns over heart attack risk. This
is all the more important for the impact of this study on patients, say
the authors, since those previously taking rofecoxib will have already
turned to the other anti-inflammatories in greater numbers.
The nature of this report an observational study
may make it prone to other explanations for the findings, say the
authors. However, enough concerns exist to warrant a reconsideration of
the cardiovascular safety of all NSAIDS, they conclude.
A separate editorial in the BMJ urges caution when
interpreting the study, and suggests that some aspects of the findings
could be explained by other factors.
Click here to see the full paper:
http://press.psprings.co.uk/bmj/june/el-gp1366.pdf
Click here to see the editorial:
http://press.psprings.co.uk/bmj/june/edit1342.pdf
In a separate study, researchers in Canada looked
at whether NSAIDS and Cox-2 inhibitors increased the risk of recurrent
heart disease or death in patients who already have congestive heart
failure.
Click here to see the full paper:
http://press.psprings.co.uk/bmj/june/el-gp1370.pdf
Click here to view full contents for this week's
journal:
http://press.psprings.co.uk/bmj/june/contents.pdf
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