London School of Hygiene & Tropical Medicine

Common painkillers such as ibuprofen and diclofenac that are used by millions of people in the UK have been linked to an increased risk of heart failure, according to new research published in the British Medical Journal.

Led by the University of Milano-Bicocca, the study analysed 10 million users of non-steroidal anti-inflammatory drugs (NSAIDs) from the UK, Italy, Germany and the Netherlands between 2000-2010. The researchers found that people who aged 77 on average, and had taken an NSAID in the previous 14 days, faced a 19% increased risk of being taken to hospital for heart failure.

The research showed the NSAIDs associated with this risk included ibuprofen, diclofenac and naproxen. The risk of heart failure actually doubled for diclofenac when taken at high doses, but the researchers urged this should be 'interpreted with caution.'

Does this research tell us anything new? And how much of a risk to these common painkillers actually pose? Stephen Evans, Professor of Pharmacoepidemiology at the London School of Hygiene & Tropical Medicine, explains:

"This is a real, but for most patients, very small risk. The risk is shown in this paper to increase with dose. In general, this has been known for a long time and higher quality data from randomised trials have also shown these effects on heart failure and also on other cardiovascular effects.

"This study, well conducted, does show some evidence, generally consistent with randomised trials, that there are some differences between different drugs. It is possible that some of these differences are due to different effective doses for the different drugs.

"The absolute risk is suggested to be about 37.5 admissions for heart failure per 10,000 person years. Because of the study design, it is possible that this is an over-estimate but it is of the right order of magnitude. The rate of admission increases dramatically with age and it is important to remember the average age of the people studied here was 77 years.

"The consequence is that it is of very little relevance to most people below age 65 taking painkillers, but in the very elderly (say above 80) that the effects are of more relevance.  For individuals it is a small increased risk."

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