NSAIDs Could Increase Risk of Cardiac Arrest

Prescription and over the counter (OTC) pain killers, such as non-steroidal anti-inflammatory drugs (NSAIDs), are typically considered to be harmless. These common drugs are used to treat minor ailments, such as headaches or acute pain.

Despite the belief that these medications are relatively safe, new study published by the European Heart Journal - Cardiovascular Pharmacotherapy suggests that NSAIDs may actually increase the risk of cardiac arrest.

“Allowing these drugs to be purchased without a prescription, and without any advice or restrictions, sends a message to the public that they must be safe,” said study author Gunnar H. Gislason, MD, PhD. “Previous studies have shown that NSAIDs are related to increased cardiovascular risk which is a concern because they are widely used.”

Included in the study were patients who had an out-of-hospital cardiac arrest between 2001 and 2010 as part of the Danish Cardiac Arrest Registry. Additional data were gathered from prescriptions for non-selective NSAIDs—diclofenac, naproxen, ibuprofen—and the COX-2 selective inhibitors rofecoxib and celecoxib. Information for OTC drugs was not obtained.

Ibuprofen and diclofenac were commonly used among this population, comprising 51% and 22% of NSAID use, respectively, according to the study.

The authors compared the use of NSAIDs during 30 days prior to cardiac arrest and the use of the drugs for a preceding 30 days without cardiac arrest.

Of the 28,947 patients who experienced an out-of-hospital cardiac arrest during this period, 3376 patients were treated with NSAIDS within 30 days of the event.

The investigators found that the use of any NSAID was linked to a 31% increased risk of cardiac arrest. Diclofenac was observed to increase risk by 50%, while ibuprofen increased the risk by 31%; however, naproxen, celecoxib, and rofecoxib were not linked to cardiac arrest.

“The findings are a stark reminder that NSAIDs are not harmless,” Dr Gislason said. “Diclofenac and ibuprofen, both commonly used drugs, were associated with significantly increased risk of cardiac arrest. NSAIDs should be used with caution and for a valid indication. They should probably be avoided in patients with cardiovascular disease or many cardiovascular risk factors.”

NSAIDs are known to influence platelet aggregation, constrict arteries, increase fluid retention, and raise blood pressure, which may explain the association with cardiac arrest, according to the study.

The authors said that naproxen is one of the safer NSAIDs, and should be used more often than diclofenac. The study authors advise that patients should seek professional advice prior to using NSAIDs, and not just assume that they are safe due to potential adverse events. These findings may provide a reason for companies to only sell the drugs through prescriptions, according to the study.

“The current message being sent to the public about NSAIDs is wrong,” Dr Gislason concluded. “If you can buy these drugs in a convenience store then you probably think ‘they must be safe for me’. Our study adds to the evidence about the adverse cardiovascular effects of NSAIDs and confirms that they should be taken seriously, and used only after consulting a healthcare professional.”