Anti-inflammatory painkillers linked to increased risk of heart attack

Source: https://www.nhs.uk/news/medical-practice/ibuprofen-linked-to-increased-risk-of-heart-attacks/

Researchers looked at data from 446,763 people and found some evidence that all commonly-used non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen appear to increase the risk of heart attack, and that the risk rises in the first week of use. The study found the risk was highest with higher doses.

And while the study tells us how likely people taking an NSAID are to have a heart attack, compared to people who hadn’t used them in the past year, it doesn’t give an indication of what the actual baseline risk of a heart attack is in these groups. And this risk varies from person to person.

It also can’t prove NSAIDs were the direct cause of heart attack – it didn’t take into account all possible influencing factors, such as smoking for example. Also, not all results reached statistical significance and so could have been the result of chance.

The study was carried out by researchers from McGill University and the Centre Hospitalier de l’Université de Montreal, both in Canada, Hospital District of Helsinki in Finland, and Leibniz Institute for Prevention Research and Epidemiology in Germany. It was funded by McGill University.

This is a meta-analysis, using individual patient data taken from large observational studies. A meta-analysis is a good way to pool data from previous research, and using individual patient data helps balance risks and avoid bias. However, observational studies cannot prove cause and effect, because confounding factors other than the ones measured may be influencing the results.

Researchers looked for observational studies based on big patient databases that investigated non-steroidal anti-inflammatory drugs (NSAID) use and heart attack. The studies compared people who’d had a heart attack with those who had not, and used prescribing data to see whether they had been prescribed NSAIDs.

The researchers analysed this data, taking account of a wide range of potential confounding factors. They calculated the risk of having a heart attack after being prescribed each of the five NSAIDs, at different time periods, and different doses.

The methods used were robust and the results from the different studies were similar, which suggests the findings are likely to apply across populations with different baseline risks of heart attack. After excluding inappropriate studies, the researchers asked for access to individual patient data to carry out their analysis. Four studies refused access, leaving them with data from four other studies – two from Canada, one from Finland and one from the UK.

The study found mixed results. Recent and current use of any NSAID is linked to a raised risk of having a heart attack, compared to someone who has not used an NSAID in the past year. However, some of these results did not reach statistically significant thresholds – meaning it’s possible that risk wasn’t increased in these cases. That said, the figures were all in the same direction – tending towards showing an increase in risk.

The raised risk was generally increased with use in the previous year or month, starting in the first week of being prescribed the drugs in the study period. It seemed highest between eight to 30 days – i.e. the first month of taking the drug. Although the risk was still raised after a month, it tailed off. There was some variation in this trend though – some NSAIDs had a higher risk after 30 days and some a lower risk.

The increased risk of heart attack for any dose of NSAIDs in the first week of use, compared to no use in the past year, was:

  • Diclofenac – a 50% increased risk (odds ratio [OR]50, 95% credible interval [CrI] 1.06 to 2.04) (credible intervals are similar to confidence intervals, but are generated by a specific kind of statistical analysis called Bayesian analysis)
  • Ibuprofen – a 48% increased risk (OR 1.48, 95% CrI 1.00 to 2.26]
  • Naproxen – a 53% increased risk (OR 1.53, 95% CrI 1.07 to 2.33)
  • Rofecoxib (a drug that has been withdrawn) – a 58% increased risk (OR 1.58, 95% CrI 1.07 to 2.17)

Higher doses (more than 1,200mg a day for ibuprofen, more than 750mg a day for naproxen and more than 25mg a day for rofecoxib) further increased the risk.

Previous studies had found a lower heart attack risk for naproxen than with other NSAIDs, but that was not apparent in this study.

This study is a useful addition to our knowledge about the links between NSAIDs and heart attack risk. The study suggests all commonly-used NSAIDs are linked to a similarly-raised risk of heart attacks, that the risk generally rises with the dose, and that it is highest in the first month of treatment.

The researchers did a good job at taking account of potential confounding factors that could have affected the results. Even so, we don’t know for sure that the NSAIDs were the direct cause of the problem. For example, if you are prescribed NSAIDs for a painful condition, and have a heart attack two weeks later, it’s hard to know whether the cause was the NSAID or the condition itself. They were also not able to take into account some known risk factors for heart attacks such as smoking and body mass index (BMI).

 

Links to the headlines

Taking painkillers for just one week ‘raises the risk of a heart attack’: Strongest doses of five types of drug can increase chance by up to half

Daily Mail, May 10 2017

Common painkillers may raise risk of heart attack by 100% – study

The Guardian, May 9 2017

‘Heart attack risk’ for common painkillers

BBC News, May 10 2017

Common painkillers may increase risk of heart attack

Sky News, May 10 2017

One week of painkillers can increase chances of heart attack, new study finds

The Daily Telegraph, May 9 2017

Painkillers raise your risk of having a heart attack within one week

Daily Mirror, May 10 2017

Taking ibuprofen to treat pain ‘for just ONE DAY increases your risk of heart attack by half’

The Sun, May 10 2017

Analysis on 44 Cases of Femoral Head Avascular Necrosis Treated with FSN Acupuncture

By Zeng F, Wang W, Sun J, Lin Y, Fu Z
Chinese Acupuncture & Moxibustion Journal July.2017, Vol.37 No.7

Abstract:
Avascular Necrosis (AVN) of the Femoral Head is a pathologic process that results from interruption of blood supply to the bone. AVN of the hip is poorly understood, but this process is the final common pathway of traumatic or non-traumatic factors that compromise the already precarious circulation of the femoral head. Femoral head ischaemia results in the death of marrow and osteocytes and usually results in the collapse of the necrotic segment. This debilitating condition always causes severe hip pain and dysfunction. Preventing this serious condition is one of the concerned project of clinical study. The authors have reviewed and analysed 44 cases of femoral head AVN treated with FSN Acupuncture , and the result is positive and encouraging.

All 44 participants, who were diagnosed as AVN of the Femoral Head, had received FSN acupuncture treatments between July 2011 and June 2015. There were 21 males and 23 females, among them there were 61 hips involved in total. The ages of the participants were between 27 and 76, and the average age was 49. The courses of disease were between 10 months and 20 years, and the average course was 32 months. The shortest period of treatment was 1 month, and the longest was 15 months.

The treatment interventions: Find out ͞Huanji͟, the pathological tight muscles (PTM), which most commonly are the following muscles: Pectineus, Iliopsoas, Sartorius, Tensor Fasciae Latae, Gluteus Maximus, and Quadriceps etc. Insert FSN needle into the soft connective tissue layer around PTMs, then perform ͞Saosan͟—swaying manipulation and Reperfusion Approach—resistance exercise technique.

Outcomes: clinical recovered: 10 out of 44 (22.7%); effective: 21 out of 44 (70.5%); ineffective: 13 out 44 (29.5%).

Comprehension: FSN is a positive treatment of Femoral Head AVN, not only for easing off the symptoms but also for slowing down the deterioration process. Previous research has shown that Obturator, Lateral Circumfiex Femoral and Medial Circumfiex Femoral are the main arteries for the femoral head blood supply, and these blood vessels all go through the muscles surrounding the hip such as Pectineus, Iliopsoas, Sartorius, Tensor Fasciae Latae, Gluteus Maximus, and Quadriceps etc. If these muscles get pathological tightness as ͞Huanji͟ by some reason, they would compress the above arteries and result in the lack of blood supply to the femoral head and cause AVN. The stimulation of FSN to the soft connective tissue around the tight muscles can generate an electro-chemical effect and result in relaxing those muscles and reducing the pressure to the blood vessels, thence improving the blood supply to the femoral head and neck, and repairing the affected tissues and cells. Treatment combination with Reperfusion Approach technique also helps to release the tension of the tight muscles and reinforce the effect of FSN, results in relieving the pain and repairing the damage of the femoral head. In addition, patients don’t have to immobilize hip joint during the treatments, they can use their legs and hips for the weight-bearing exercise and activitiesof daily living, benefiting for their quality of life.

(Edited and translated by Wenbo Xu)

CPD Courses

Venue: Cambridge

Date: 17 / 11/2018

FSN Reperfusion Approach Techniques

Speaker: Ms Yuan Wei

A one day workshop by experienced practitioner Yuan Yuan. Ms Wei has had Crown of Miss Beauty of China in 1990s.

Venue: London

Date: 18/11/2018