Medicines like these fall into a category of painkillers known as non-steroidal anti-inflammatory drugs ( NSAIDs). These medications may raise a person’s relative risk of heart failure by nearly 20 percent, according to the analysis of medical records for nearly 10 million patients.
That risk increases with the amount of NSAIDs a person is taking, said study author Andrea Arfe, a Ph.D. student at University of Milano-Bicocca, in Italy.
A person’s risk of hospitalization for heart failure doubles for some NSAIDs used at very high doses, including diclofenac ( Cataflam or Voltaren), etoricoxib (Arcoxia), indomethacin ( Indocin), and piroxicam ( Feldene), Arfe said.
Also, “our findings — which focused only on prescription NSAIDs — might apply to over-the-counter NSAIDs as well,” Arfe said. “Although over-the-counter NSAIDs are typically used at lower doses and for shorter durations, they are sometimes available at the same doses as prescription NSAIDs and they may be inappropriately overused.”
Still, the nature of the study can only point to an association between NSAID use and heart failure risk — it can’t prove cause-and-effect. And one expert believes that most patients who need an NSAID for their pain can safely continue using the drugs.
The findings were reported Sept. 28 in the BMJ.
According to the American Academy of Orthopaedic Surgeons (AAOS), NSAIDs decrease inflammation and pain by blocking an enzyme called cyclooxygenase. This enzyme comes in two forms, COX-1 and COX-2. COX-1 protects the stomach lining from digestive acids, while COX-2 is produced by injured or inflamed joints.
Traditional NSAIDs — like aspirin or ibuprofen — block the action of both COX-1 and COX-2, which is why some people suffer from stomach upset after taking them, the AAOS said. Newer NSAIDs like celecoxib ( Celebrex) target only COX-2, and are referred to as COX-2 inhibitors.
Doctors have been concerned for some time that NSAIDs might play a role in heart failure, because they cause people to retain sodium, explained Dr. Christopher O’Connor, editor-in-chief of the cardiology journal JACC: Heart Failure.
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