Nonsteroidal anti-inflammatory drugs (or NSAIDs) are some of the most widely used drugs worldwide. Because some of these drugs can be bought without prescription, the common perception is that they are safe and harmless, meaning, they don’t cause any side effects. As it turns out, this perception might actually be a misconception.
Based on a study that was recently published in the European Heart Journal Cardiovascular Pharmacotherapy, NSAIDs in general increase a person’s risk of cardiac arrest by 31%. Diclofenac increases that risk by an astounding 50%, while ibuprofen increases the risk by 31%. Other NSAIDs like celecoxib, naproxen and rofecoxib were not associated with a higher risk, probably because these drugs aren’t used as often.
To come up with the results, the research team led by Dr. Gunnar Gislason (cardiology professor at Copenhagen University Hospital) used the Danish Cardiac Arrest Registry to collect and analyze the medical history of around 30,000 patients who suffered out-of-hospital cardiac arrest from 2001 to 2010. Then they obtained NSAID prescriptions redeemed at Danish pharmacies since 1995. They specifically focused on celecoxib, diclofenac, ibuprofen, naproxen and rofecoxib. They were not able to obtain information about ibuprofen because it happens to be the only non-prescription NSAID in Denmark and is available in small dosages (200 mg).
For each patient, the team looked at the use of NSAIDs 30 days before the incidence of cardiac arrest (called case period) and compared this with the use of NSAIDs 30 days prior to the case period. Out of the 28,947 patients, 3,376 were treated with an NSAID up to 30 days before the cardiac arrest happened. And the most commonly given NSAIDs were ibuprofen and diclofenac.
Previous research has already shown that NSAIDs affect the cardiovascular system in a number of ways, which is why these drugs are linked with cardiac arrest. Effects include fluid retention, increased blood pressure, constriction of arteries and blood clot formation. This latest study corroborates this information, and goes further by pinpointing which specific NSAIDs were the ‘riskiest’ — diclofenac — and the safest — naproxen.
As study author Dr. Gunnar Gislason (cardiology professor at Copenhagen University Hospital) said in a statement they issued: “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… Diclofenac is the riskiest NSAID and should be avoided by patients with cardiovascular disease and the general population. Safer drugs are available that have similar painkilling effects so there is no reason to use diclofenac.”
Dr. Gislason added that people should limit their intake of naproxen to no more than 500 mg per day, and ibuprofen to a maximum of 1,200 mg per day. He also went as far as saying that these particular NSAIDs should not be sold in convenience stores, groceries and supermarkets where no medically-trained personnel can advise consumers on proper use. More importantly, taking these NSAIDs should only be done upon the recommendation of a healthcare professional.