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20-01-2011 | General practice | Article

Common painkillers raise CV risk

Abstract

BMJ 2011; 342: c7086

Commonly used painkillers including traditional non-steroidal inflammatory drugs (NSAIDs) as well as the newer cyclo-oxygenase (COX)-2 inhibitors may increase the risk of myocardial infarction (MI) and stroke, research published in the BMJ shows.

The study's authors say that ongoing uncertainty over cardiovascular (CV) safety of these drugs means that CV risk should be taken into account when prescribing any NSAID.

The Swiss team, led by Peter Jüni from the University of Bern, analysed 31 trials involving around 120,000 patients that compared any NSAID with another NSAID or placebo.

Both rofecoxib (now withdrawn) and lumiracoxib were associated with two-fold increased risks of MI compared with placebo. Ibuprofen was linked to the highest risk of stroke, at more than a three-fold risk increase, followed by diclofenac, at just under a three-fold increase in stroke risk.

Meanwhile etoricoxib and diclofenac were associated with the highest risk of CV death, at around four-fold increased risks versus placebo.

As previously found in other analyses, naproxen appeared to be the least harmful of the NSAIDs analysed in terms of overall CV risk.

In a related editorial, Wayne Ray from Vanderbilt University in Nashville, Tennessee, USA, pointed out that the ongoing PRECISION trial should provide clearer information on the relative CV safety of naproxen, celecoxib and ibuprofen - but that for now naproxen "seems to be the best choice with regard to CV safety".

GP News is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Caroline Price