THE QUESTION Once someone has had a heart attack, is it ever safe to take a type of painkiller called an NSAID (nonsteroidal anti-inflammatory drug), commonly used to ease joint and muscle pain?
THIS STUDY analyzed data on 99,187 adults (average age, 69) who had had a first heart attack. In the five years that followed, 44 percent of them were prescribed such NSAIDs as ibuprofen (Advil, Motrin), naproxen (Aleve) and celecoxib (Celebrex). In that time, 36,747 people died; nonfatal heart attacks and deaths attributed to heart problems numbered 28,693. People who had taken NSAIDs at any point during this span were more likely to have died than those who did not take the painkillers: 59 percent more likely in the first year after the heart attack, 63 percent in the five-year period. They also were more apt to have had another heart attack or to have died from a coronary cause: 30 and 41 percent at one and five years, respectively. Chances of having a heart attack, fatal or not, fell each year after the initial attack for people who did not take NSAIDs, but that did not happen for those who took the painkillers, with their risk at five years remaining as high as it was right after the initial attack.
WHO MAY BE AFFECTED? People who have had a heart attack, which occurs when blood flow to the heart is blocked. More than a million people in the United States have a heart attack each year. Despite advances in treatment, about half of them quickly die or suffer permanent damage, usually because they did not get immediate help.
CAVEATS In the early years of the study, some participants took rofecoxib (Vioxx), which was pulled from the market in 2004 because of safety issues; risks were highest for those who took this painkiller. Even NSAIDs with lower risks (naproxen had the lowest cardiovascular risk in the study) can cause gastrointestinal bleeding. The authors noted that the risk for death from any cause may have been greater than for heart-related deaths because all participants had heart problems, and that deaths attributed to other factors, such as lung disease or infection, were “influenced by their heart disease.”
FIND THIS STUDY Sept. 10 online issue of Circulation.
The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment's effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.