Overall Risk Small
The study, by Consuelo Huerta, MD, MPH, of the Spanish Center for Pharmacoepidemiologic Research in Madrid, Spain, looked at data on 228,660 patients collected in the U.K. from 1997 through 2000.
While the NSAID drugs increased patient's risk, the overall risk was small for most. However, the drugs are considerably more dangerous for those who already have heart failure.
"Use of NSAIDs was associated with a small risk of a first hospitalization for heart failure," Huerta and colleagues report. "In patients with a prior clinical diagnosis of heart failure, the use of NSAIDs may lead to worsening of pre-existing heart failure that triggers their hospital admission."
The study appears in the current early online edition of the journal Heart.
NSAIDs and Blood Pressure
The new findings don't surprise heart experts, says Andrew L. Smith, medical director for the heart failure and transplant programs at Emory University in Atlanta.
"The data from this study is not surprising to those of us who manage a lot of patients with heart failure," Smith tells WebMD. "NSAIDs can contribute to high blood pressure. This is not commonly recognized among primary care providers. It is a difficult situation, because a lot of heart patients have arthritis and other problems for which these medicines provide relief."
With all the attention given the heart risks of Vioxx, it's easy to forget that over-the-counter painkillers also have risks, says Carl Lavie, MD, medical co-director of cardiac rehabilitation and preventive cardiology, Ochsner Clinic Foundation in New Orleans.
"Doctors don't think anything of giving patients these NSAIDs that raise blood pressure, inhibit the aspirin they need for heart disease prevention, and increase the risk of heat attacks and strokes," Lavie tells WebMD. "And now this paper, like others before it, shows higher heart failure risk. Doctors have to recognize that all these drugs have risks -- not just the ones advertised by the lawyers."
Blood Pressure Drugs
For people taking blood pressure drugs -- diuretics (water pills), ACE inhibitors, or beta-blockers -- there's an even greater risk. Even short-term use of NSAIDs boosts heart failure-related hospitalizations in these patients, the Huerta study shows.
Smith says the problem isn't that NSAIDs are directly toxic to the heart. But because of the way they work, they counteract the effects of blood pressure drugs. In patients whose lives depend on these drugs, the effects can be severe -- and sudden.
"In our clinic, we can see an immediate impact when an advanced heart failure patient takes an NSAID," Smith says. "One day their diuretic is working. The next day, fluid retention puts them in the hospital. It depends on the underlying heart disease whether the effect is this dramatic."
Ochsner Clinic cardiologist Homeyar Dinshaw, MD, tells patients who need an NSAID to keep a sharp lookout for telltale signs of water retention.
"Recently, I have started telling patients that if they take an NSAID, they should watch out for fluid retention," he says. "They do this by checking their weight at the same time every morning. And at other times, I have them check the skin just below the sock line. If you press over the bony surface just a bit above the ankle and get an indentation, you are retaining water."
Smith has a better idea. Heart patients who need painkillers, he says, should take acetaminophen -- Tylenol, for example -- instead of an NSAID.
By Daniel J. DeNoon, reviewed by Louise Chang, MD
SOURCES: Huerta, C. Heart, May 22, 2006; early online edition. Andrew L. Smith, medical director, heart failure and transplant programs, Emory University. Homeyar Dinshaw, MD, staff cardiologist, Ochsner Clinic Foundation, New Orleans. Carl Lavie, MD, medical co-director of cardiac rehabilitation and preventive cardiology, Ochsner Clinic Foundation, New Orleans.