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Taking popular painkillers such as Ibuprofen could kill people who've suffered a heart attack, according to new research.
Scientists looked at patients who had previously had a heart attack and started taking the prescription drugs.
They found the use of the tablets, known as non-steroidal anti-inflammatory drugs (NSAIDs), was associated with a 45 per cent increased risk of death or recurrent heart attack within as little as one week of treatment
There was a 55 per cent increased risk if treatment with the tablets extended to three months.
NSAIDs are commonly used and are associated with increased cardiovascular risk in people with heart disease or those at high risk.
In a 2007 statement, the American Heart Association advised physicians about the risks of NSAID use among heart patients and provided a stepped care approach.
The statement also advised extra caution for when NSAIDs might be used, noting that they should 'be limited to patients for whom there are not appropriate alternatives, and then, only in the lowest dose and for the shortest duration necessary.'
In the current study, researchers investigated if the duration of prescription NSAID treatment influenced the cardiovascular risk among heart patients.
Among 83,697 heart attack survivors (average age 68; 63 per cent men), 42.3 per cent had a least one prescription for an NSAID.
The most common NSAIDs prescribed were ibuprofen (23 per cent) and diclofenac (13.4 per cent). Selective COX-2 inhibitors b rofecoxib (4.7 per cent) and celecoxib (4.8 per cent) b were also used. The non-selective NSAID diclofenac was associated with early onset risk similar to the selective COX-2 inhibitor rofecoxib.
All NSAIDs were associated with an increased risk of death or recurrent heart attack, with diclofenac having the highest risk.
The study's lead author Anne-Marie Schjerning Olsen, a research fellow at Copenhagen University in Denmark, said: 'Overall, NSAID treatment was associated with a statistically significant increased risk of death.
'Our results indicate that there is no apparent safe therapeutic window for NSAIDs in patients with prior heart attack.'
The NSAID naproxen was not associated with an increased risk of death or recurrent heart attack. However, previous studies found increased gastrointestinal bleeding with naproxen.
Dr Olsen said: 'A very conservative approach to use NSAIDs in patients with prior heart attack is warranted.
'If NSAID therapy is necessary for patients with known heart attack, the doctors should choose an NSAID less selective for COX-2 and a minimum for the shortest period.'
She said low-dose ibuprofen was the only available over-the-counter NSAID available in Denmark and was only dispensed in limited quantities of 100 tablets at a time, so over-the-counter use of NSAIDs was unlikely to have had a major effect on the study results.
In some countries, diclofenac is available as an over-the-counter drug without warnings about potential side effects. Recently, the U.S. Food and Drug Administration issued a warning that diclofenac should not be used by patients recovering from heart surgery.
However, Dr Olsen added: 'The accumulating evidence suggests that we must limit NSAID use to the absolute minimum in patients with established cardiovascular disease.'
She said further study is warranted to establish the cardiovascular safety of NSAIDs.
Doctor Elliott Antman, lead author of the 2007 NSAIDs advisory, said: 'The American Heart Association applauds this research that adds to our knowledge about the adverse effects of NSAID use in patients with coronary artery disease.
'The authors further confirm our prior practical advice that NSAID use should be avoided and if unavoidable should be used at the smallest doses for the shortest time possible. Naproxen has not been shown to have an increased cardiovascular risk and may be safer than other NSAIDs.'
The research was published in Circulation: Journal of the American Heart Association.
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