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After a heart attack, some painkillers may increase your risk of recurrence

A recent study suggests that people who have a history of heart attack are at greater risk having another attack or even dying after taking certain types analgesic prescription or nonprescription, such as Advil, Motrin or Voltarin for a week.

Danish researchers analyzed national registries of nearly 84,000 heart attack survivors and found that those taking certain nonsteroidal antiinflammatory drugs (NSAIDs) for a week faced a risk 45 percent more likely to have another attack. The use of these drugs for three months increased the risk to 55 percent.
results support the statement by the American Heart Association in 2007 that alerted doctors on the risk of prescribing NSAIDs to patients and recommended its use only to the lowest dose for the shortest time necessary.

"These results indicate that there is an apparently safe therapeutic window for NSAIDs in patients who have suffered a previous heart attack, and questioned the safety of the recommendations of use and short-term low doses of NSAIDs " said study author Dr. Anne-Marie Schjerning Olsen, a research associate at the University of Copenhagen in Denmark.

The study appears in the online edition of Circulation, May 9.

most common NSAIDs were prescribed to participants in the study were ibuprofen (Advil, Motrin) and diclofenac (Cataflam, Voltaren). Diclofenac accounted for the highest cardiovascular risk, even much higher than rofecoxib (Vioxx), an NSAID that was banned in 2004 in the U.S. due to the high rate of heart attacks and strokes among those taking it.
The Food and Drug Administration of USA. UU. issued a warning saying that patients recovering from heart surgery should not take diclofenac.
A popular NSAID, naproxen (Aleve), was not associated with an increased risk of death or recurrent heart attack in the study, although it has been associated with gastrointestinal bleeding.

"We were surprised that the commonly used NSAIDs such as diclofenac, which in some countries is sold without a prescription and without the advice of an expert to warn of potential side effects, were linked with an increased risk and that this risk was maintained during the course of treatment, "said Olsen .
All NSAIDs block the production of the enzyme COX, which comes in two forms. Drugs that inhibit the enzyme COX-2 (which include Celebrex) have a higher chance of blood clots associated other NSAIDs that inhibit COX-1, said Dr. Elliott Antman, professor of medicine at Brigham and Women's Hospital and Harvard Medical School in Boston.

"For example, aspirin, an NSAID that has anticoagulant properties, blocking the enzyme COX-1," Antman said, "and has long been considered helpful for preventing heart attacks when used in low dose. " Antman and Olsen Both agreed that the low dose that is usually given to patients, daily aspirin may not represent an added risk for recurrence of heart attack.

Moreover, the new results "does not surprise us, and we feel really support the recommendations we have made," said Antman , who was also the author of the information about NSAIDs in 2007 of the AHA.
"We felt there was a risk in the use of NSAIDs if the patient had ischemic heart disease or were at risk for this disease... We were never convinced that these drugs were safe," said Antman .

Olsen and his team noted that the new study was limited by its observational nature, so a prospective trial random would provide greater certainty on the issue. However, the data were complete, and that came from the Danish National Patient Registry, he said, and a national registry of prescriptions recorded all medications prescribed to the public since 1997.
Among the nearly 84,000 heart attack survivors studied, with an average age of 68 years, over 42 percent had at least one prescription for an NSAID, the study said. Low-dose ibuprofen is the only nonprescription NSAIDs in Denmark, so it was unlikely that its use significantly affect the results of the study, said Olsen.

Antman noted that heart patients take NSAIDs sometimes despite the risks if you have severe pain due to other conditions such as rheumatoid arthritis or lupus. First be used non-pharmacological methods of pain relief, such as physical therapy and splints heat, or other type of medication before using NSAIDs.

"Some patients have debilitating arthritis and need to take them into account in the list [of NSAIDs], knowing that as we move into the list we move to an increasingly dangerous territory," said Antman .
"If you take an NSAID, they should continue doing so for a long time. Many doctors do not monitor the use of medications and patients continue to take a long time after overcoming his heart problem."