PAIN-KILLERS ( NSAIDs ) AND THE HEART

If you will remember, about 5-6 years ago, we were all concerned that VIOXX, a new pain-killer then, maybe causing more heart attacks. Just a brief overview. There are many types of pain-killers in the market. However, for common pains, especially arthritic pain, many of us use voltaren, or ibuprofen, or naproxen. These drugs belong to a group of drugs called the NSAID ( non-steriodal anti-inflammatory drugs ), as opposed to steriods which is also a powerful pain killer but with many side effects. NSAID however suffered from a propensity to cause gastric upset and bleeding. Researchers then found a new group of drugs called the COX2 inhibitors, which were anti-inflammatory ( reduce inflammation and pain ), but does not upset the gastric. They thought that they have found a blockbuster. As it turns out in 2004, the use of VIOXX ( the first COX2 inhibitor to hit the market ), was associated with an increase incidence of heart attacks. It was quickly withdrawn, amissed much "hooha" and many court cases are still pending.
Even as we were concerntrating on COX2 and the heart, we seemed to have forgottent to investigate the older version, NSAID and the heart. Is NSAID safe?
Well, the June 8th issue of Circulation, Cardiovascular Outcomes carried an article by Dr Emil Loldrup of Denmark. He and his colleagues in Denmark, did a search on 1 million Danes, who had used any NSAID, and related these to deaths from cardiac causes, including heart attacks. They found that the use of all NSAIDs were associated with an increase incidence of heart attacks. The worse being diclofenac ( found in Malaysia in 2 common brands namely voltaren and also cataflam ). The safest being Naproxen. Diclofenac was as dangerous as VIOXX.
Before we all panic, we must remember that this is an observational study, and the data collected is not very reliable. It depends on how deaths have been reported. The fact that someone has a prescription for diclofenac does not always mean that they took them.
It however gives us a rough guide that we should use diclofenac with some caution, especially if you have a high CV risk profile.
I have always advised my patients that we should only use drugs when they are clearly indicated, not as smarties whenever we feel like it. With reference to NSAID pain-killers, if you have a high CV risk profile, use them with a small daily does of aspirin.
As usual, remember, drugs and any therapy must always do more good then harm. If you are not sure, ask your favourate GP. That money is not worth saving.