Pharmacy and primary care organisations have called for caution following a recent headline warning of a link between heart failure and NSAIDs

Seven commonly prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and two COX-2 selective NSAIDs could increase the risk of heart failure by a fifth, according to a recent study published in the BMJ and widely reported in the media.

Researchers from the University of Milano-Bicocca in Italy analysed data from nearly 10 million adults taking NSAIDs in four European countries. Overall, patients who were currently using NSAIDs had a 20 per cent higher risk of hospital admission for heart failure than those who had not taken the analgesics for about six months. However, the risk varied considerably depending on dosage and between different types of NSAID (with potent drugs such as ketorolac carrying a greater risk than more commonly used NSAIDs, such as ibuprofen).

Study limitations

Responding to the findings, John Smith, PAGB chief executive, pointed out that the study focused solely on prescription-only NSAIDs, which contain a higher dosage than those available over the counter.

Mr Smith also stressed the fact that the study participants were mainly older patients who were taking NSAIDs for chronic conditions such as arthritis, whereas, occasional use of the painkillers by younger people to ease acute aches and pains was unlikely to be a cause for concern.

“Furthermore, heart failure is often associated with other cardiovascular diseases which could mean that some of the people analysed were already at higher risk of heart failure prior to the study,” he added.

Risks and benefits

Despite the limitations of the study, consultant cardiovascular pharmacist and Royal Pharmaceutical Society spokesperson, Helen Williams, said that it reinforced the need for healthcare professionals “to carefully weigh up the risks and benefits of NSAID therapy” and ensure that patients taking these analgesics for long durations receive “careful monitoring to assess the ongoing suitability of NSAID therapy”.

In addition, while more research is needed to assess the safety of over-the-counter NSAIDs, Ms Williams urged pharmacy teams to be alert to customers who regularly request these medicines.

“Patients with concerns as a result of these new data should seek advice from their pharmacist or doctor, particularly where they are taking regular NSAIDs purchased without healthcare professional support,” she said.