NSAIDs are short for NonSteroidal Anti-Inflammatory Drugs. They include ibuprofen (e.g. Motrin and Advil), naproxen (Aleve), and prescription-only diclofenac (e.g. Voltaren and Cataflam), celecoxib (Celebrex), and rofecoxib (Vioxx, now withdrawn).
NSAIDs are not benign. People who read this blog probably know this, but NSAIDs:
- Raise blood pressure and when taken consistently can contribute to hypertension.1
- Adversely affect the kidneys. (They decrease the kidney's filtration rate (Glomerular Filtration Rate: GFR) and cause sodium and fluid retention.)2
- Increase risk for bleeding.
- Increase risk for heart attack.
- Increase risk for stroke.
It's the last two in this list that have been drawing attention. Earlier this year a group of researchers from Denmark reported in the American Heart Association's prestigious journal Circulation that short-term use of NSAIDs increased risk for heart attack - in healthy people. We already knew about the heart attack risk with NSAIDs, but not its effect on an apparently healthy population.
They started with the entire Danish population over 10 years, over 4.5 million people, and filtered out anyone who had been admitted to the hospital within the past 5 years and had no chronic use of any serious medication. That left a little over one million people. This was not an insignificant study.
The above was heart attack risk. Last month at the European Society of Cardiology's 2010 Congress, the same authors reported an increased risk for stroke from NSAIDs in a similar large and healthy Danish population.
One of the study's authors, Dr. Gunnar Gislason:
"This is very serious, as these drugs are very widely used, with many available over the counter. ... We need to get the message out to healthcare authorities that these drugs need to be regulated more carefully."From that same Heartwire article:
"Gislason noted that there was also a dose-relationship found, with the increased risk of stroke reaching 90% (HR 1.90) with doses of ibuprofen over 200 mg and 100% (HR 2.0) with diclofenac doses over 100 mg. He pointed out that the results were particularly striking, given that this study was conducted in healthy individuals."Doses of ibuprofen over 200mg? That's anything more than one cheap over-the-counter Advil caplet.
"If half the population takes these drugs, even on an occasional basis, then this could be responsible for a 50% to 100% increase in stroke risk. It is an enormous effect."NSAIDs are effective pain relievers. Sometimes need for pain relief outweighs risk for heart attack or stroke. Who should weigh this? The consumer or the physician? Should NSAIDs be made available only by prescription?
2 Renal Effects Of Cyclooxygyenase-2-Selective Inhibitors, Journal of Pain and Symptom Management, 2002
"[NSAIDs] are associated with adverse renal effects caused by the reduction in synthesis of renal prostaglandins through inhibition of cyclooxygenase (COX)."