The drugs include traditional non-steroidal anti-inflammatory drugs (NSAIDS) as well as new generation anti-inflammatory drugs, known as COX-2 inhibitors.
NSAIDs have been the cornerstone of managing pain in patients with osteoarthritis and other painful conditions.
So researchers in Switzerland performed a comprehensive analysis of all randomised controlled trials comparing any NSAID with other NSAIDs or placebo.
They included 31 trials and 116,429 patients taking seven different drugs (naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib, lumiracoxib) or placebo to provide a more reliable estimate of the cardiovascular risks of these drugs than previous studies.
Overall, the number of harmful outcomes that could be compared for placebo versus treatment was low.
In 29 trials there was a total of 554 heart attacks; in 26 trials there were 377 strokes, and in 28 trials there were 676 deaths. So the absolute risk of cardiovascular problems among people taking painkillers was low, but the researchers did find that, relative to placebo, the drugs carried important risks.
For instance, compared with placebo, rofecoxib and lumiracoxib were associated with twice the risk of heart attack, while ibuprofen was associated with more than three times the risk of stroke.
Etoricoxib and diclofenac were associated with the highest risk of cardiovascular death.
Naproxen appeared least harmful in terms of cardiovascular safety among the seven analyzed preparations.
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