A recent study – conducted by an international team of researchers from Canada, Finland and Germany – suggests the link between common painkillers and an increased risk of getting heart attacks.

The team analysed the individual data of 446,763 patients to discover the outcome which may change the way clinicians approach the prescription of painkillers in the future.

Non-steroidal anti-inflammatory drugs

NSAID painkillers – one of the most common painkillers in the market – work by inhibiting the COX enzyme within our bodies, resulting in reduced inflammation, pain and fever. Examples of common NSAIDs include aspirin, celecoxib, ibuprofen, naproxen and diclofenac.

Readily available in pharmacies and hospitals worldwide at a relatively low cost, it is for this reason that NSAIDs have been a widespread success across the globe.

That being said, NSAIDs are not miracle drugs and have their fair share of side effects. Common side effects of NSAID use include gastrointestinal symptoms which can be fairly benign such as diarrhoea, constipation and decreased appetite to more serious problems; such as gastric ulcer and bleeding.

If used above recommended dosages or for a prolonged period of time, NSAIDs may lead to kidney and liver failure. While the rates of these complications are often low among patients, clinicians are always mindful when it comes to prescribing NSAIDs.

Increased heart attack risk with NSAIDs

Published on 9 May 2017, epidemiologist Michèle Bally and an international team of researchers discovered a positive association between NSAID usage and an increased risk of heart attacks. The research team analysed the clinical data of 446,763 patients – with an emphasis on the 61,460 patients who suffered from heart attacks.

From the analysed data, the team discovered that taking any dose of NSAIDs for more than one week was associated with an increased risk of heart attacks. Moreover, the risk was found to increase as duration of intake lengthened – with the highest risk being within the first month.

The risk of heart attacks for patients taking NSAIDs for more than a month were found to be no higher than those having taken it for less than a month. In addition, the risk of heart attacks was also found to be increased with higher doses of NSAIDs.

Lower dosages of painkillers reinforced

It has long been established that painkillers should be taken in small doses for the shortest period of time possible. Moreover, the usage of painkillers above the recommended dosage is ill-advised due to the slew of side effects associated with it.

As such, the study serves to reinforce the advocacy of low doses and short duration. Previous studies and present clinical practice guidelines already warn about the usage of NSAIDs in patients with heart problems and stroke due to the high bleeding risk.

With the results from this new study, future guidelines may be updated to present the effects of long-term NSAID usage and, potentially, the need for patients at high risk of heart problems. With hope, these new results may mark a shift away from the usage of NSAIDs in the management of long-term pain.

Moving forward

While clinicians and researchers know about the dangers and pitfalls of long-term painkiller usage, these research findings serve as an important reminder of the need to enforce such a stance. More important than doctor’s practices, however, is the need for more patients to be educated on proper painkiller usage. This is in view of the fact that many of these painkillers are easily accessible – and at a low cost. As a result, patients are susceptible to abusing them without the knowledge of their family doctor.

These new research findings certainly mark an important step in the optimal prescription of painkillers. However, further research is necessary to better understand this drug. MIMS

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