Arthritis painkillers raise stroke, heart attack risk by more than a third, landmark study suggests

So ask your doctor which of these risk reduction ideas will counteract the use of these painkillers. You do expect your doctor to know this, don't you?
http://life.nationalpost.com/2013/05/30/arthritis-painkillers-raise-stroke-heart-attack-risk-by-more-than-a-third-landmark-study-suggests/
Millions of arthritis sufferers could be increasing their risk of a heart attack or stroke by more than a third by taking large doses of drugs such as ibuprofen, according to one of the largest studies into painkillers.
The study of more than 350,000 patients taking prescription doses of such medications found the chance of a heart attack or stroke rose by almost 40%.
The research found that the greater risk of cardiac side-effects from ibuprofen was similar to those of another arthritis drug, Vioxx, which was withdrawn from the market almost a decade ago when research suggested it might double the risk of heart attacks.

The painkillers were also found to double the risk of heart failure and bleeding ulcers when taken in high quantities

The painkillers, which are known as non-steroidal anti-inflammatory drugs (NSAIDs) and taken by millions of arthritis sufferers each day, were also found to double the risk of heart failure and complications such as bleeding ulcers when taken in high quantities.
The authors of the University of Oxford study said that their findings showed that prolonged use of such medicines was “risky”, but added that patients needed to weigh up the benefits against the potential dangers.
More than seven million people in Britain suffer from rheumatoid arthritis and osteoarthritis, and many rely on high doses of NSAIDs, which are also sold in lower quantities over the counter for common ailments.
The study, published in The Lancet, found that for every 1,000 people with a moderate risk of heart disease, about eight would normally have a heart attack or stroke each year.
When similar patients were given a year of treatment with a high dose of ibuprofen (2,400 milligrams daily) or another NSAID called diclofenac (150mg daily), that risk rose, with 11 patients suffering major cardiac events.
One in three of the extra heart attacks was fatal, the study found.
The same dosage, which is the maximum normally prescribed and twice the amount allowed over the counter, more than doubled the risk of heart failure from three cases in 1,000 to seven, and more than doubled the risks of complications such as bleeding ulcers.
If all seven million people with arthritis took the highest dosage of drugs, it would equate to an estimated 21,000 more heart attacks in sufferers, the study suggested.

‘We are trying to say yes, these drugs are risky, but it may be worth it’

Researchers said the study, funded by the Medical Research Council and the British Heart Foundation and led by the council’s unit at Oxford, had looked at the risks from common painkillers in “unprecedented detail.”
The lead author, Colin Baigent from the University of Oxford, said: “The research shows that, when used in high doses, diclofenac and ibuprofen increase the risk of cardiovascular disease, on average causing about three extra heart attacks a year in every 1,000 patients treated, one of which would be fatal.”
He added: “For many people who take these drugs for severe arthritis they make the difference between being able to go about their daily life or not. We are trying to say yes, they are risky, but it may be worth it.”
The findings, from an analysis of 639 randomized trials, found that a third drug, called naproxen, did not increase the risk of heart attacks or strokes when a high dose of 1,000mg a day was taken.
The study found that it was the most likely of the medications to cause bleeding from the stomach, but researchers said such problems were normally less serious.
Researchers said the cardiac risks from ibuprofen and diclofenac were “mainly relevant” to people with arthritis who were prescribed high doses or long periods. “A short course of lower dose tablets purchased without a prescription, for example, for a muscle sprain, is not likely to be hazardous,” said Prof Baigent.
Last year almost 17 million prescriptions were written by doctors in England for NSAIDs. About a third were for ibuprofen, a third for diclofenac and about a sixth for naproxen.
Alan Silman, the medical director of Arthritis Research UK, urged arthritis sufferers not to be “unduly concerned,” but said family doctors were turning increasingly to naproxen because of the potential cardiac risks of the other medications. He said: “There is an urgent need to find alternatives that are as effective, but safer.”
Dr. Shannon Amoils, research advisor at the BHF, said: “People should take the lowest effective dose of these drugs for the shortest time necessary.”