July 13, 2011
Sanjeev Suratwala, MD
The use of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, is considered the cornerstone of medical treatment of osteoarthritis. A new study has recently suggested that there may be a tie between the duration and use of NSAIDS and recurrent heart attacks. These medications are comprised of ingredients known to reduce pain and fever, and in higher doses, have anti-inflammatory properties. They are favored because they are non-narcotic and not considered to be habit-forming. They are also available over the counter in lower strengths.
These medications work by affecting the cyclooxygenase enzymes, which are important in the process of inflammation. Most NSAIDs affect both types of this enzyme, but newer medications like Celebrex only affect one type of this enzyme, potentially reducing the side-effect of gastrointestinal (GI) bleeding. The most common side effects of NSAIDS are ulcer formation, bleeding, and affect on the kidneys. Recent studies have suggested that these medications can increase the risk of heart attacks in patients with coronary artery disease.
A recent article in the journal Circulation reviewed the duration of treatment with non-steroidal anti-inflammatory medications in relation to the risk of death and recurrent heart attacks in patients with prior heart attacks. Over a 10 year period, a total of 102,138 patients were admitted with a first-time heart attack, and of these 83,675 (81.9 percent) were included in the study. Diclofenac (brand names Cataflam, Voltaren XR, Arthrotec) was associated with increased risk from the beginning of treatment, whereas Ibuprofen showed an increased risk when used for more than one week, and Celebrex after 14 to 30 days. Naproxen (brand names Aleve, Naprosyn) was not associated with increased risk for the entire duration treatment.
The increased risk of heart attack and/or death was reportedly quite low but was statistically significant. So what does this mean?
An underlying diagnosis of coronary artery disease, especially with a history of heart attack, may make the treating physician reconsider the use of NSAIDs, especially diclofenac and ibuprofen. Given the choices, naproxen may be strongly considered, though it does have an increased risk of GI bleeding compared to the other medications.
Alternatives for patients and physicians to consider include Tylenol (acetaminophen) as well as Ultram (tramadol) for short-term use. Narcotic medications are to be used sparingly and should not be considered for long-term treatment of osteoarthritis. All medications have their own specific side effects which need to be evaluated.
The use of medications in treating osteoarthritis should be considered part of a multi-pronged strategy including a proper diet, weight management and an exercise program.
As with any treatment, consult your doctor to see which treatment is most appropriate for you.