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Common Painkillers Raise Heart-Attack Risk, Study Indicates June 10-- Commonly used painkillers and anti- inflammatory drugs such as ibuprofen may raise the risk of heart attacks, according to the biggest study of its kind published in the British Medical Journal. The heart attack risk rose 24 percent for people taking ibuprofen and 55 percent for diclofenac, according to researchers from the University of Nottingham, England, who did an observational study of first-time U.K. heart attack patients. Wyeth sells ibuprofen under the Advil brand and Novartis AG markets diclofenac as Voltaren. Painkillers have come under scrutiny since Merck & Co.'s Sept. 30 withdrawal of Vioxx, or rofecoxib, which was shown to raise the risk of heart disease. Vioxx is a so-called COX-2 inhibitor, a class of anti-inflammatory drugs designed to replace older non-steroidal medicines, which were associated with gastrointestinal side effects. ``Our study offers no reassurance that the increased risk of myocardial infarction is specific to rofecoxib alone or specific to COX-2 inhibitors,'' lead researcher Julia Hippisley-Cox said in her study. ``We think that enough concerns exist to warrant a reconsideration of the cardiovascular safety of all NSAIDs.'' For people 65 and over age taking diclofenac, one extra patient for every 521 patients was likely to suffer a first-time heart attack. For Vioxx the figure was one patient for every 695 patients; and for ibuprofen, one patient for every 1,005 patients was at risk, the study indicated. Still, patients shouldn't stop taking the drugs involved until there is further confirmation of the results, researchers Hippisley-Cox, a professor of clinical epidemiology and general practice, and Carol Coupland, a senior lecturer in medical statistics, said in their study. `Difficult for Doctors' ``It will be very difficult for doctors to choose the right painkiller for arthritis patients,'' Luis Miranda, a rheumatologist at the Instituto Portugues de Reumatologia in Lisbon, said in a telephone interview from Vienna. `We will have to be more careful with doses and the length of ************ because most of our patients are old and have a higher risk for heart disease than the general population anyway,'' said Miranda, who's attending the European League Against Rheumatism, or Eular, Congress, and who didn't take part in the study. The English researchers studied 9,218 cases of a first-ever diagnosis of heart attack between 2000 and 2004 and a control group of 86,349 others aged between 25 and 100 in a U.K. general practitioners database. NSAIDs are commonly prescribed to relieve inflammation and pain. Painkillers They included painkillers such as ibuprofen, diclofenac, naproxen, which is sold as Naprosyn by Basel, Switzerland-based Roche Holding AG and Aleve by Leverkusen, Germany-based Bayer AG as well as Whitehouse Station, New Jersey-based Merck's Vioxx and Pfizer Inc.'s Bextra and Celebrex. Vioxx has been withdrawn and Bextra suspended. ``We believe in Voltaren, which has a long history of treating pain in patients,'' said John Gilardi, a spokesman for Basel, Switzerland-based Novartis. ``We have 30 years of clinical studies and actual use to support its efficacy and safety.'' In a April 7 statement, New York-based Pfizer said it's collected Celebrex clinical data in the past 10 years involving more than 40,000 patients and said it will conduct more studies evaluating the benefits and risks of Celebrex. Bayer spokesman Hartmut Alsfasser declined to comment, saying the German company will have to analyze the data. Roche's Martina Rupp also declined to comment. The risk for patients prescribed NSAIDs in the three months just before their heart attack rose between 24 percent and 55 percent compared with those who hadn't taken these drugs in the previous three years. Celebrex and naproxen had similar odds ratios, though the results may have been affected by the small sample size. |
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Not for Everyone Although aspirin is a familiar and readily available drug, people shouldn't take it for its cardiovascular benefits without discussing the risks of long-term use with a doctor, cautions Charles H. Hennekens, M.D., chief of preventive medicine at Brigham and Women's Hospital in Boston. "If someone feels they're a candidate, they should talk to their doctor in making the judgment if the benefits outweigh the risks." The same quality that gives aspirin its potential benefit--its ability to inhibit clotting of the blood--may increase the risk of excessive bleeding, including the possibility of bleeding in the brain. Some other possible risks are:
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