Widely used prescription and non-prescription painkillers are associated with an increased risk of hospital admission for heart failure, according to a study released on Thursday. The drugs in question are so-called NSAIDs, or non-steroidal anti-inflammatory drugs, including several known as COX-2 inhibitors.
Many are among the most commonly used drugs to alleviate pain and inflammation, and some were introduced over a century ago with minimal safety checks. The broad link between the use of NSAIDs and heart failure is well established, but which drugs pose the greatest risk, and at what doses, remains poorly understood.
To get a clearer picture, a team of researchers led by Giovanni Corrao at the University of Milano-Bicocca combed through the medical records of nearly 10 million NSAID users in four European countries: Germany, Britain, the Netherlands and Italy.
They identified 92,163 hospital admissions for heart failure and then checked to see which of 27 drugs - and at what doses - each of them was taking. Overall, they found that current use of NSAID slightly raised the risk of hospital admission compared to past use for nine drugs.
These included diclofenac, ibuprofen, indomethacin, ketorolac, naproxen, nimesulide, and piroxicam, along with two COX 2 inhibitors, etoricoxib and rofecoxib.
At very high doses, some doubled the risk of hospital admission. The researchers emphasised that the study was observational, meaning that it did not benefit from the controlled conditions of an experiment and thus could not draw firm conclusions about cause and effect.