Should you be worried about ibuprofen causing heart failure?
A new study has shown a link between heart failure and a class of painkillers that includes ibuprofen. The story has received widespread news coverage, much of which sounds quite alarming.
For most people, particularly the under-65s and those without heart problems, the answer is no. The study showed that the risk is still very small for most people. Most people under 65 are not at risk of heart failure unless they have heart problems already.
The research suggests that the increase in risk is about 37.5 admissions for heart failure per 10,000 person years – a relatively small number.
What’s more, these drugs are already well-known to be linked to heart failure, heart attacks and strokes. Most doctors already avoid prescribing them to people with these issues. And concerns about these drugs apply mostly to people who take them on a daily basis rather than for an occasional headache.
What did the research find?
This large study looked at the health records of more than 8 million patients, with an average age of 77, and whether they had used non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen and diclofenac.
The increase in risk was higher for some drugs such as diclofenac, and lower for ibuprofen
People who had used an NSAID in the previous fortnight were found to have a 19 per cent higher risk of hospital admission for heart failure (after the researchers adjusted the figures to take into account other factors which would influence the results). The increase in risk was higher for some drugs such as diclofenac, and lower for ibuprofen. Taking a higher dose of these drugs was found to increase the risk.
The association between the use of NSAIDs and an increased risk of heart failure has been known about for years. What this study adds is more detail about the effects of individual drugs in this group, and the effect that different doses can have on the risk.
The reasons behind all this are that NSAIDs can cause the kidneys to retain more salt and water in the body, which can increase your risk of heart failure. They can also make some blood pressure-lowering medicines, such as ACE inhibitors and diuretics, less effective – and a rise in blood pressure is likely to worsen heart failure.
What were the strengths and weaknesses of the study?
The researchers identified some limitations of the study. It looked only at prescription NSAIDs, although they said it “might apply to NSAIDs obtained over the counter as well”. Over-the-counter NSAIDs are more likely to be used by younger people, and for shorter periods of time than when they’re prescribed, although the researchers pointed out that people might still take them at the same dose, and/or overuse them.
However, the fact that they didn’t look at non-prescription use means some of those classed as not using NSAIDs might have been using them after all. The researchers said that this is more likely to mean that their findings “understate the actual association between use of individual NSAIDs and heart failure risk” rather than that they might have found an association which wasn’t there.
A strength of the study is that it looked at a very large number of patient records
A strength of the study is that it looked at a very large number of patient records, and combined five different sources of data from four European countries, meaning that the effects found are more likely to be widely applicable and less likely to be a quirk of one particular study group.
It’s possible that there were differences in the patients – for example that those taking NSAIDs were more ill, or that they might have had a condition linked to increased risk of heart failure and which would also require pain relief (such as gout) – that could have affected the results. The researchers tried to adjust for this in their analysis, but they may not have fully accounted for it, which could explain some of the difference in risk.
How was this story covered in the media?
The story was covered widely and the headlines were alarming. “Ibuprofen link to heart failure”; “Common painkillers linked to increased risk of heart failure”; “Taking ibuprofen could raise heart risk by a fifth”; “Painkillers like ibuprofen may raise risk of hospital admission for heart failure”.
Much of the news coverage did not make it clear that the link between NSAIDs and increased heart risk is already well-known.
Although there were some exceptions, overall the coverage failed to stress that the results found in a group of elderly patients may not apply to younger patients.
Overall the coverage failed to stress that the results found in a group of elderly patients may not apply to younger patients
The BHF view
Professor Peter Weissberg, former Medical Director at the British Heart Foundation, said: "Overall the coverage failed to stress that the results found in a group of elderly patients may not apply to younger patients.
“It has been known for some years now that such drugs need to be used with caution in patients with, or at high risk of, heart disease. This applies mostly to those who take them on a daily basis rather than only occasionally.
“Since heart and joint problems often coexist, particularly in the elderly, this study serves as a reminder to doctors to consider carefully how they prescribe NSAIDs, and to patients that they should only take the lowest effective dose for the shortest possible time. They should discuss their treatment with their GP if they have any concerns.”