NSAIDs Increase Death Risk after Heart Attack

Pain relievers called non-steroidal anti-inflammatory drugs (NSAIDs) taken after a heart attack increase the risk of death, a new Danish study shows.

The new research was presented on Sunday, at the American Heart Association's scientific sessions 2005 in Dallas. The study's results show that the higher the dose of NSAIDs, the higher the risk of death. However, the study didn't find any connection to a second heart attack. The study did not include aspirin, which is known to benefit patients after a heart attack.

Dr. Gunnar H. Gislason, of Bispebjerg University Hospital in Copenhagen, Denmark, who led the study, advises that the results of the study should be viewed in relation to the rest of the evidence. Although it would be best for heart attack patients to avoid NSAIDs, patients with severe pain may choose to be treated with these drugs, on the condition that they discuss benefits and risks with their doctors.

NSAIDs (including aspirin, ibuprofen and naproxen) carry a risk of gastrointestinal bleeding. Cox-2 inhibitors are NSAIDs that do not present that risk. In September 2004, concerns were raised about the cardiovascular safety of Vioxx, a Cox-2 inhibitor, which was then withdrawn from the market; Bextra, Celebrex and Naproxen followed, of which Bextra was withdrawn from the market as well.

The Danish study was the first to look at the effects of NSAIDs on patients who took them after suffering their first heart attack. The records of 58,432 men and women in the Danish National Patients Registry were analyzed; the researchers chose patients discharged from hospital between 1995 and 2002 after their first acute heart attack.

Men and women who were administered more than 200 mg a day of Celebrex (celecoxib) had a 4.24 times higher risk of death as compared to those who did not take NSAIDs at all. Those taking more than 25 mg of Vioxx (rofecoxib) had a 5.03 times increased risk, and those taking more than more than 100 milligrams a day of Cataflam and Voltaren (diclofenac) had a 3.76 times higher risk. Those taking other NSAIDs presented a 1.22 higher risk of death and for people taking more than 1,200 mg a day of ibuprofen (Advil, Motrin), there is a 1.96 times increased chance of death.

Lower doses of Vioxx and Celebrex also cause a higher risk of death, but lower doses of diclofenac and ibuprofen do not. "NSAIDs are associated with an increased risk of death in high doses, but not in low doses", Dr. Gislason concluded.

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