NSAID

"Could painkillers increase our risk of a heart attack?" OU academic explains

Research by the University of Montreal Hospital Research Centre, published in The British Medical Journal (BMJ), suggests that nonsteroidal anti-inflammatory drug (NSAID) painkillers could increase the risk of heart attacks. The study of five NSAID painkillers, including ibuprofen, concluded that the risk of suffering from a heart attack was as much as 50% greater in those using the drugs compared to those that are not.

So should we be concerned? Emeritus Professor of Applied Statistics, Kevin McConway, has deciphered the figures and explains more.

What type of study is this?

"This is an observational study, which means that conclusions cannot be made about cause and effect. That’s because the researchers couldn’t take into account all the factors that might influence both the prescribing of painkillers  and the chance of a heart attack, usually because they did not have adequate data on them. The research report mentions several such factors – smoking, obesity, income, education, and taking painkillers bought over the counter (and so not recorded in the data). So, for instance, perhaps people who smoke are more likely to be prescribed painkillers, and are separately more likely to have a heart attack.

"Or, putting it crudely, if someone is prescribed a high dose of a painkiller because of severe pain, and then has a heart attack in the following week, it’s pretty hard to tell whether the heart attack was caused by the painkiller or by whatever was the reason for prescribing the pain killer (or indeed by something else entirely)."

Will painkillers really increase my risk of a heart attack?

"In the UK, according to the British Heart Foundation, there were about 190,000 hospital visits due to heart attacks in 2015.

"It’s true the researchers conclude there is a chance of over 90% that each of the painkillers is associated with an increased heart attack risk; but that says nothing about the size of the increase. A very tiny increase in risk probably doesn’t matter. It also means that there is a chance, albeit a fairly small one (less than 10%), that painkiller use actually decreases the heart attack risk."

Should we be worried about taking painkillers?

"Although this new study has helped persuade me that there is probably a real association between taking these painkillers and heart attacks, some aspects do still remain pretty unclear. It is possible that the painkillers aren’t actually the cause of the extra heart attacks, and there’s still a lot of uncertainty about the strength of the relationships and about how they vary with dose and with the timing of taking the painkillers.

We have to remember that all drugs have side effects, and that people aren’t prescribed these painkillers for fun, but to deal with a real pain problem.