Reality check: Do common painkillers increase your risk of heart attack?

If you’re reaching for common painkillers, new research is warning that these drugs could be raising your risk of a heart attack as early as the first week of use.

Scientists out of McGill University say that heart attack risk is especially amplified within the first month of taking high doses of NSAIDs – non-steroidal anti-inflammatory drugs.

But keep in mind, this is only for people who are taking these medications excessively and have an elevated risk of heart disease.

READ MORE: 5 tips for spring cleaning your medicine cabinet

Based on their findings, the researchers are now urging doctors and patients to consider the risks and benefits for common painkillers. They studied:

• Ibuprofen, commonly known as the brand names Advil or Motrin
• Diclofenac, or Voltaren
• Celecoxib, or Celebrex
• Naproxen, or Aleve

Tylenol – or acetaminophen – is not an NSAID. Aspirin was also excluded.

“In real life, most people use these drugs in low and varying doses, sometimes on and off and they even switch between NSAID medications. Our objective really was to better understand the risk of heart attack in these drugs used to treat pain and inflammation in the real world,” study lead author, Dr. Michele Bally, an epidemiologist and researcher at the Montreal university, told Global News.

“Taking any dose of NSAIDs for one week, one month, or more than a month was associated with an increased risk of myocardial infarction…risk was greatest during the first month of NSAID use and with higher doses,” Bally wrote in her study published in the BMJ, formerly the British Medical Journal.

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An acute myocardial infarction is more commonly known as a heart attack. Previous research has already suggested that painkillers increase the risk, but the timing, effect of certain dosages and treatment duration haven’t been closely studied.

For her study, Bally looked at the habits of patients leading up to a heart attack. Her research is a meta-analysis of studies carried out from Canada, Finland and the United Kingdom.

Altogether, 446,763 people were studied, 61,460 of whom had had a heart attack.

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Turns out, the overall increased risk of a heart attack is about 20 to 50 per cent if using a painkiller compared to those who weren’t using these drugs.

The risk was emphasized if people took 1,200 milligrams of ibuprofen daily – that’s about six Advil tablets. Risk also increased for those taking 750 milligrams of naproxen – that’s about 3.5 Aleves.

Risk “manifested” within a week of usage and the highest risk occurred at the one-month mark. After that, the risk didn’t creep up higher, though. The researchers guess that’s because anyone who would be susceptible to heart problems would have encountered them by then.

READ MORE: Taking acetaminophen for arthritis pain? It’s no better than placebos

Single heart attacks were only counted, too. Once a patient in the study encountered a heart attack, they were excluded from study observation – Bally doesn’t know if the patients went on to experience secondary heart events.

But there are some caveats: the study authors say this is an observational study based on drug prescribing and there could be other influential factors at play that haven’t been explored.

Still, the team says it’s the “largest investigation of its type” and involves real-world data.

The findings provide a good opportunity for Canadians to consider how often they’re turning to over-the-counter painkillers, according to Dr. Cara Tannenbaum. She’s a practicing geriatrician, pharmacy chair at the University of Montreal and director of the Canadian Deprescribing Network.

READ MORE: Chronic back pain? New guidelines call for exercise, heat pads – painkillers a last resort

After looking at Health Canada’s database for adverse reactions to medicine, she said that about 800 people reported negative events, namely heart side effects.

Consumers need to ask themselves:

• Do I need to take this medication now?
• Do I still need this medication?
• Can I reduce the dosage or even stop taking this medication?
• How does this drug interact with my other medications?
• What are the benefits and harms tied to this drug?
• Are there safer non-drug options?

“This is a good time to alert people and encourage them to always ask these questions to pharmacists, doctors or nurses…there’s this assumption that just because it’s over-the-counter, it’s benign,” Tannenbaum said.

READ MORE: Have high pain tolerance? Don’t ignore these signs of a ‘silent’ heart attack

If you’re grappling with back pain, for example, heating pads or massages could be other options that are medication-free.

Deciphering what to reach for when you’re grappling with pain is tricky, especially for those with chronic pain, experts say.

“A particularly difficult decision will be in patients with inflammatory arthritis – such as rheumatoid arthritis – as they often need NSAIDs to damp down the inflammation to control pain and stiffness in the joints,” Dr. Mike Knapton, associate medical director at the British Heart Foundation, told NBC News.

It shouldn’t be an issue for everyday Canadians who aren’t at high risk of a heart attack and don’t often rely on painkillers to begin with, though.

If you don’t have cardiovascular risk factors, such as a family history of heart disease, a smoker, diabetic, have high blood pressure or high cholesterol, your risk is much lower, Bally said.

“The baseline risk is extremely low, well below one per cent,” she told Global News.

See Bally’s full findings.

carmen.chai@globalnews.ca
Follow @Carmen_Chai