A handful of nonsteroidal anti-inflammatory drugs, including ibuprofen or diclofenac, are linked to an increased risk of hospitalization for heart failure.
Aspirin, ibuprofen and other commonly used nonsteroidal anti-inflammatory drugs (NSAIDs) are linked to an increased risk of heart failure, reveals a European study published this Thursday in British Medical Journal.
These analgesics are among the best-selling drugs in France. Ibuprofen is also the 2th drug most dispensed in pharmacies, just behind doliprane and its 500 million boxes sold in 2013. These drugs obtained without a prescription are not trivial.
Numerous studies have shown that they can disrupt the heartbeat, increase the risk of stroke or heart attack if taken regularly. This recent work suggests a new danger: they increase the risk of hospitalization linked to heart failure.
More than 8 million patients followed
To reach this conclusion, researchers at the University of Milan-Bicocca (Italy) searched the medical records of 8 million Dutch, British, Italian and German patients over the age of 18. All received a traditional NSAID or a selective COX-2 inhibitor or coxibs, a new subclass of NSAIDs.
Between 2000 and 2010, more than 92,000 of them were admitted to hospital with heart failure.
Researchers show that patients who took one of these drugs in the two weeks prior to emergency treatment are 19% more likely to be hospitalized. In-depth analyzes reveal that around ten molecules are to be blamed: diclofenac (sold under the name Voltarene and its generics), ibuprofen, indomethacin, ketorolac, naproxen, nimesulide and piroxicam, as well as as two coxibs called etoricoxib (Arcoxia) and rofecoxib (Vioxx withdrawn from the world market in 2004).
For naproxen and ketorolac, the risks of admission to hospital vary from 16 to 83%, while this risk is more than doubled for diclofenac, etoricoxib, indomethacin, piroxicam, and rofecoxib used in high doses.
Thus, the risk of hospitalization for heart failure linked to these drugs seems to depend on the molecule and the dose administered, the researchers conclude.
Regulate access to these drugs
In a commentary accompanying the study, two Danish cardiology professors express their concern. “Even a small increase in cardiovascular risk is a concern for patients,” they write, recalling that these drugs can be bought in supermarkets in many European countries where no professional health advice is available. Which is not the case in France.
Cardiologists also point out that the European and American drug agencies have alerted patients and prescribers on several occasions to the potential dangers of these molecules, and in particular of diclofenac.
An editorial in the journal of the European Society of Cardiology even called on doctors to stop prescribing the drug. The two authors therefore call for reinforced regulation to reduce the accessibility of these drugs and guarantee the safety of patients.
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