Risk of irregular heart rhythm from NSAIDs is low

The use of NSAIDs, commonly known as painkillers, including ibuprofen are already known to be associated with cardiovascular risk but a new study, published in the BMJ, showed for the first time a link between the drugs and atrial fibrillation or flutter (AF) also known as irregular heart rhythm.

Danish researchers examined the records of more than 32,000 patients who had a first diagnosis of AF between 1999 and 2009 and compared each to 10 randomly selected control patients.They found that patients starting treatment with non-aspirin NSAIDs had 40-70% increased risk of AF compared to non-users. New users of cox-2 inhibitors, the newer forms of the drugs, were associated with a 70% increased risk.

The lead author concluded that the overall increased risk was still low and patients taking these medicine should not stop them but should discuss the potential risks with doctor. One-off doses or short courses of over-the-counter-strength ibuprofen are still considered safe.

In an accompanying editorial, the author said doctors should be cautious when precribing NSAIDs to older people because of the higher risk of AF.

Critics say that this was a population-based case control study with many strengths, but the lack of data on the amount of NSAIDs taken by the patients, confounders, lifestyle factors etc. could have affected the results.

Source: Schmidt M, Christiansen CF, Mehnert F, et al. Non-steroidal anti-inflammatory drug use and risk of atrial fibrillation or flutter: population based case-control study. BMJ 2011; 343:d3450 ( open access)

Editorial : Gurwitz JH. NSAIDs and atrial fibrillation. BMJ 2011, 343: d2495 (open access)

Lancet study confirms Vioxx risk

Vioxx, a pain killer, was withdrawn from the market in 2004 after the APPROVe trial showed that it doubled the risk of heart attacks.


In a new study published in The Lancet, researchers contacted 84% of the people who took part in the original trial and confirmed the findings of previous study. They also found that a year after stopping the treatment, participants still had increased risk of heart attack, stroke or death comapred with those in the placebo group. The researchers raised the concern that long term use of of all non-aspirin NSAIDs may have a similar effect and suggested doctors to weigh up the benefits of these drugs in individual patients.


The drugmaker, Merck, issued a statement :"....this post-hoc analysis using limited data from a prematurely terminated study needs to be interpreted very cautiously......".



Source: Baron JA, Sandler RS, Bresalier RS et al. Cardiovascular events associated with rofecoxib: final analysis of the APPROVe trial. The Lancet 2008; Oct 14 [Early online publication]

Painkillers reduces breast cancer risk

Researchers carried out a meta-analysis of 38 relevant studies carried out in 5 different countries and involving 2.7 million women to examine the association between NSAID use and breast cancer.


The combining results from all 38 studies show that the use of NSAIDs was associated with a 12% reduction in risk of breast cancer. Analysis of all studies examining aspirin use only found a 13% reduction in the risk while the ibuprofen analysis found a 21% reduction in the risk of breast cancer. The authors conclude that there was an overall decreased risk of breast cancer with NSAID use.


Critics say that the use of aspirin and ibuprofen is not without risk in themselves and warn that long-term use of these painkillers would have serious side effects.


Source: Takkouche B, Regueira-Méndez C, Etminan M. Breast Cancer and Use of Nonsteroidal Anti-inflammatory Drugs: A Meta-analysis. Journal of the National Cancer Institute 2008; Oct 7 [Epub ahead of print]

Regular use of painkillers could cut Alzheimer's risk

A few newspapers reported a study that has found regular use of ibuprofen, aspirin and other painkillers known as NSAIDs reduces the risk of developing the Alzheimer's disease. Doctors warn that people should not take over-the-counter pain remedies to ward off dementia as there are side effects. The finding is based on a review of six studies involved almost 14,000 people.

Researchers concluded that NSAID use reduced the risk of Alzheimer’s disease. However, they did not find that a sub-group of NSAIDs, known as the SALAs, more effective than other non-SALAs in preventing the disease. This suggests that all conventional NSAIDs have a similar protective effect in humans.

Critics say this was a review of selected studies and that the risk from bleeding need to be considered against any benefits.

Source: "No advantage of A 42-lowering NSAIDs for prevention of Alzheimer dementia in six pooled cohort studies." Neurology 2008; May 28 [Epub ahead of print]

Aspirin daily reduces breast cancer risk

News sources reported a new study that found women who took aspirin, known as non-steroidal anti-inflammatory drugs (NSAIDs) daily were 16% less likely to develop breast cancer.


Researchers studied the questionnaire responses from a previous study conducted in 2003 and used the answers to relate the use of NSAIDs to the chance of developing breast cancer. They concluded that "breast cancer risk was not significantly associated with NSAID use, but daily aspirin use was associated with a modest reduction in oestrogen-receptor (ER)-positive breast cancer." However they suggested further research is required as other studies have shown conflicting results.


Source: "Nonsteroidal anti-inflammatory drugs and breast cancer risk in the National Institutes of Health–AARP Diet and Health Study" Breast Cancer Research 2008, 10:R38doi:10.1186/bcr2089 ( free f/t)

Cod liver oil can cut arthritis drug use

The Daily Mail reported cod liver oil can cut the daily dose of anti-inflammatory drugs needed to ease the pain of arthritis.

The report is based on a small double-blind randomised controlled trial of 97 people aged 37 - 78 with rheumatoid arthritis for an average of 13 years and taking regular NSAID medication. The participants were randomly assigned to either daily capsules of cod liver oil and fish oil or a placebo over 9 months.

60% of participants completed the study, 39% in the cod liver oil group were able to reduce their NSAID intake by about 30% compared with the placebo group. The researchers concluded that cod liver oil capsules could be used by arthritis sufferers to cut their NASID intake.

The study was funded by a company that sells cod liver oil capsules and other food supplements and was published in the journal Rheumatology.

Source: "Cod liver oil (n-3 fatty acids) as an non-steroidal anti-inflammatory drug sparing agent in rheumatoid arthritis" - Rheumatology, published online on March 24, 2008

Non-prescription painkillers may reduce risk of Parkinson's Disease

A study of 293 patients with Parkinson's Disease found that regular use of some non-prescription drugs known as NSAIDs reduced the risk of developing the disease. The protection persisted for 2 years after the patients stopped taking the drugs.

However, researchers warned that regular use of high dose aspirin and non-aspirin NSAIDs may cause gastrointestinal bleeding and other risks.

Source: "Nonsteroidal anti-inflammatory drugs may protect against Parkinson disease" Neurology 2007; 69: 1836-1842. (Subscription required for f/t)