NSAIDS Linked To Heart Attack, Stroke

Earlier this year, a study in the American Heart Association's journal Circulation reported an increased risk of heart attack with use of nonsteroidal anti-inflammatory drugs (NSAIDs) in healthy individuals (over 1 million individuals included in the analysis).¹ It wasn't the first study to find this risk with NSAIDS; however, prior studies looked at those who had heart disease or were at increased risk for it, not apparently healthy people.

Last month at the European Society of Cardiology's 2010 Congress, the same authors reported an increased risk for stroke with use of NSAIDS in a similar large and healthy Danish population. Speaking to Heartwire, Dr. Gunnar Gislason, one of the authors said:

"This is very serious, as these drugs are very widely used, with many available over the counter. ... We need to get the message out to healthcare authorities that these drugs need to be regulated more carefully."

Gislason thinks NSAIDS need better management, preferring they not be available without a prescription:

"If half the population takes these drugs, even on an occasional basis, then this could be responsible for a 50% to 100% increase in stroke risk. It is an enormous effect."

Examples of NSAIDS currently available in the US without prescription are ibuprofen (e.g. Motrin and Advil) and naproxen (Aleve). Diclofenac (e.g. Voltaren and Cataflam), celecoxib (Celebrex), and rofecoxib (Vioxx, now withdrawn) are NSAIDS that require a prescription.

Mechanism

NSAIDS are thought to increase cardiovascular and cerebrovascular risk via:

• Increased coagulative effect, with risk of thrombus.
  
• Increased bleeding, especially associated with stroke.
  
• Increased blood pressure. (This is an effect of all NSAIDS.)²
  
• Adverse effects on kidneys. (NSAIDS can lead to sodium and water retention, and a decrease in glomerular filtration rate (GFR).)³

Sometimes benefit outweighs risk. NSAIDS are effective pain relievers. The decision to start NSAIDs should be based on an individual's cardiovascular risk and the specific need for pain relief.
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¹ Cause-Specific Cardiovascular Risk Associated With Nonsteroidal Antiinflammatory Drugs Among Healthy Individuals, Circulation, 2010
² NSAIDs, Coxibs, and Cardio-Renal Physiology: A Mechanism-Based Evaluation: Coxibs and Hypertension, Medscape, 2002
³ Renal Effects Of Cyclooxygyenase-2-Selective Inhibitors, Journal of Pain and Symptom Management, 2002

"[NSAIDS] are associated with adverse renal effects caused by the reduction in synthesis of renal prostaglandins through inhibition of cyclooxygenase (COX)."