The increased risk of heart attacks and strokes associated with the use of the COX-2 nonsteroidal anti-inflammatory drugs (NSAIDs) refocoxib (Vioxx) and valdexocib (Bextra) led to their removal from the market several years ago. And questions still remain about the safety of celecoxib (Celebrex), the only COX-2 NSAID still available by prescription.
What about the cardiovascular risks associated with the other painkillers?
Studies have come up with different conclusions on this question. But the FDA has mandated a warning on all NSAIDs except aspirin, whether obtained with a prescription or over-the-counter (OTC).
One common recommendation has been to use acetaminophen (Tylenol) instead of an NSAID. Now, a report based on a 12-year follow-up of nearly 71,000 participants in the Nurses' Health Study supports the FDA warning and even adds acetaminophen to the painkillers associated with cardiovascular risk.
The authors of the study concluded that heavy use of OTC NSAIDs and acetaminophen placed women at higher risk for fatal and non-fatal heart attacks and strokes. A 35 to 45 percent greater risk was identified in women who used NSAIDs or acetaminophen more often than 21 days a month.
The risk was particularly high among smokers. Among women who took 15 or more pain pills a week, the likelihood of cardiovascular complications was increased by 86 percent for NSAIDs and by 68 percent for acetaminophen compared with non-users of pain medications.
No increased risk was found in nonsmokers, in women who reported using OTC NSAIDS or acetaminophen for 1 to 21 days a month, or with any use of aspirin.
The Nurses' Health Study included only women, so it is important to point out that these findings may not apply equally to men. Also, while the increased risks are significant they are not dramatic.
Nonetheless, you should be cautious about using large amounts of these medications, especially if you have heart disease or risk factors for it. Since they can be obtained without a prescription, your doctor may not know that you are using them in large amounts. You should talk to your doctor about pain requiring extensive use of these drugs.
