Tuesday, June 11, 2013

Review study published by Lancet on Pain Medication and the risk of Vascular disease

According to a review study published in the journal The Lancet, regular intake of pain-relieving non-steroidal anti-inflammatory drugs (NSAIDs) in high doses, doubles the risk of a variety of heart problems.

A comprehensive review of 650 randomized trials involving more than 350,000 patients showed that those who daily consumed either 2.4 mg ibuprofen or 150 mg Diclofenac, increased their risk of heart disease, stroke, and death by one third. At the same time people who took high doses of NSAIDs also two to four times as likely to have ulcers or other gastrointestinal problems.

Findings

Major vascular events were increased by about a third by a coxib (rate ratio [RR] 1·37, 95% CI 1·14—1·66; p=0·0009) or diclofenac (1·41, 1·12—1·78; p=0·0036), chiefly due to an increase in major coronary events (coxibs 1·76, 1·31—2·37; p=0·0001; diclofenac 1·70, 1·19—2·41; p=0·0032). Ibuprofen also significantly increased major coronary events (2·22, 1·10—4·48; p=0·0253), but not major vascular events (1·44, 0·89—2·33). Compared with placebo, of 1000 patients allocated to a coxib or diclofenac for a year, three more had major vascular events, one of which was fatal. 
 
Naproxen did not significantly increase major vascular events (0·93, 0·69—1·27).  
 
Vascular death was increased significantly by coxibs (1·58, 99% CI 1·00—2·49; p=0·0103) and diclofenac (1·65, 0·95—2·85, p=0·0187), non-significantly by ibuprofen (1·90, 0·56—6·41; p=0·17), but not by naproxen (1·08, 0·48—2·47, p=0·80).  
 
The proportional effects on major vascular events were independent of baseline characteristics, including vascular risk. Heart failure risk was roughly doubled by all NSAIDs. All NSAID regimens increased upper gastrointestinal complications (coxibs 1·81, 1·17—2·81, p=0·0070; diclofenac 1·89, 1·16—3·09, p=0·0106; ibuprofen 3·97, 2·22—7·10, p<0 2="" 4="" and="" div="" naproxen="" p="">

Interpretation

The vascular risks of high-dose diclofenac, and possibly ibuprofen, are comparable to coxibs, whereas high-dose naproxen is associated with less vascular risk than other NSAIDs. Although NSAIDs increase vascular and gastrointestinal risks, the size of these risks can be predicted, which could help guide clinical decision making.







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