COX 2 vs. NSAIDs: Both May Double Risk of Heart Attack

By: Karen Barrow
High doses of some common pain relievers, non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, may increase one's risk of stroke or heart attack as much as COX 2 inhibitors, a new study shows.
This news comes a few months after the U.S. withdrawal of two commonly-prescribed pain relievers, Vioxx and Bextra, because of studies that showed these drugs, called COX 2 inhibitors, can increase by up to five times a person's risk of heart attack and stroke when taken in high doses.

Many people were initially given COX 2 inhibitors as a pain reliever because they may be gentler to the stomach then NSAIDs, which are linked to serious gastrointestinal side effects, such as ulcers. But many patients switched back to NSAIDs because of the increased cardiac risk. This change may have been made in vain.

"COX 2 inhibitors are associated with a moderate increase in the risk of vascular events, as are high dose regimens of ibuprofen," writes lead study author, Dr Patricia Kearney and colleagues in the British Medical Journal.


The study included a review of previous studies measuring the cardiac risk imposed by both COX 2 inhibitors and traditional NSAIDs, including the commonly used pain relievers, ibuprofen and naproxen.

Taken together, the studies included almost 140,000 patients and confirmed that, for patients taking Cox 2 inhibitors, there is an approximately 86 percent greater risk of heart attack than those who do not use the drug. However, the study also found that the risk of heart attack appeared to be equally high among patients who used NSAIDs.

The increased heart attack risk was not seen with naproxen, however, which the authors suggest may be because this drug works a little differently than the others.

What is not yet known is whether certain NSAIDs raise the risk of a cardiac complication more than others. The authors state that more studies need to be done before determining which pain reliever is the best for dealing with chronic pain.