Painkillers may pose risk after heart attack

Last Updated: 2006-06-19 16:00:11 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Among people who have survived a heart attack, taking certain types of painkillers is associated with an increased risk of a repeat heart attack or death, investigators in Denmark have found.

The elevated risks apply not only to COX-2 inhibitors (which include drugs like Vioxx) but also so-called nonselective nonsteroidal anti-inflammatory agents (NSAIDs) like ibuprofen or diclofenac.

"Patients who have already suffered a heart attack appear be more vulnerable to the harmful effect of these medications," said Dr. Gunnar H. Gislason said in press release from the American Heart Association.

Gislason, from the Gentofte University Hospital in Hellerup, and colleagues extracted data from the Danish National Patient Registry on 58,432 patients age 30 or older who had survived a first heart attack between 1994 and 2002.

They then mined the Danish Registry of Medicinal Product Statistics for information regarding prescriptions of NSAIDs as well as selective COX-2 inhibitors, their dosages, and how long they were prescribed.

During follow-up, 9773 of the patients had another heart attack and 16,561 died, the team reports in the American Heart Association's journal Circulation.

Taking a low dose of a COX-2 inhibitor was tied to an approximate doubling of the risk of dying and about a 50 percent increase in the chances of having another heart attack. At higher doses, mortality risk was increased five-fold.

With high daily doses of NSAIDs, the likelihood of dying was doubled or quadrupled depending on the specific drug, and the risk of another heart attack went up 22 to 89 percent.

Given the results from this and other studies, Gislason's team writes, "COX-2 inhibitors and nonselective NSAIDS should be used with particular caution in patients with a prior (heart attack)."

SOURCE: Circulation, online June 19, 2006.