'Safe' Drug Link to Heart Attacks

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http://www.truthout.org/issues_05/061005HC.shtml

 

'Safe' Drug Link to Heart Attacks

By Sarah Boseley

The Guardian UK

 

Friday 10 June 2005

 

Millions face painkiller dilemma.

 

Nine million people with arthritis were yesterday left in a

dilemma as ibuprofen, a painkiller which has long been considered one

of the safest drugs on the market, was linked with heart attacks.

 

The news will dismay those who depend on drugs to reduce the

stiffening in joints, alleviate the pain and allow them to lead a

normal life.

 

The question mark over ibuprofen, of which Nurofen is one of the

best known brands, and the other less well-known non-steroidal

anti-inflammatories (NSAIDS) follows on the heels of the crisis over a

newer class of medicines used for the same purpose.

 

The drug company Merck took its best-selling Vioxx off the market

after trials showed it, too, was linked with heart attacks. A whole

class of drugs, known as the Cox2 inhibitors, is now under investigation.

 

The biggest support group for people with arthritis made a

heartfelt plea yesterday for doctors to advise them on what they

should do.

 

" Medicine is an important element in the treatment for the vast

majority of people with arthritis. There is now much confusion and

worry over the risks associated with many of the medicines used for

arthritis, " said Neil Betteridge, chief executive of Arthritis Care.

 

" We urgently need the medical profession to take a lead in helping

people with arthritis decide what treatment is right for them. Of

course, any medicine that brings a benefit is likely also to carry a

risk of some side effects. Indeed, doing nothing to manage your

condition may also carry a risk.

 

" However, there needs to be very clear communication of both the

risks and benefits associated with each and every treatment.

 

" Ultimately, it is the person with arthritis who will decide what

to take for their condition and their decision needs to be an informed

one. "

 

Confidence in ibuprofen, which as an over-the-counter painkiller

had sales of over 200m in 2000, was further dented by a study

published last week by researchers at the University of Southern

California, who said they had identified a link to breast cancer.

 

Today's paper, published in the British Medical Journal, comes

from academics at Nottingham University, who identified 9,218 patients

in England, Scotland and Wales aged from 25 to 100 who had suffered a

first heart attack.

 

They then looked to see if they had been taking NSAIDS and Cox2

inhibitors.

 

Their results were adjusted for factors linked to heart attacks,

such as age, heart disease, smoking habits and whether they were also

taking aspirin, which reduces the heart attack risk.

 

They found that the risk of a heart attack was increased in those

who had taken the drugs in the three months before their heart attack.

 

For ibuprofen, the risk rose by almost a quarter (24%) - higher if

they had been on it longer - and for a similar drug called diclofenac

it rose to 55%.

 

The increased risk with the Vioxx (generic name rofecoxib) was 32%

and with an other Cox2 called Celebrex (celecoxib) it was 21%.

 

The authors were particularly concerned about older NSAIDS like

ibuprofen, because many people will have switched to them after the

furore over the Cox2s. For every 1,005 people over 65 taking

ibuprofen, they say, one will have a heart attack.

 

The authors, Julia Hippisley-Cox, professor of clinical

epidemiology and general practice, and Carol Coupland, senior lecturer

in medical statistics, call for an investigation of the heart risks of

all these drugs.

 

They say that given the high prevalence of the use of these drugs

in elderly people and the increased risk of heart attack with age,

there could be considerable implications for public health.

 

In a separate editorial in the BMJ, Peter Juni, senior research

fellow in clinical epidemiology at the University of Berne, and

colleagues say that some of the results of the study could be

explained by other factors.

 

Large-scale clinical trials comparing the efficacy and

side-effects of the drugs may be necessary to determine the best

treatment for people with musculoskeletal pain, they say.

 

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