Widely used OTC drugs increase stroke risk in healthy people

The latest class of drugs whose safety is being questioned are the so-called nonsteroidal anti-inflammatory drugs (NSAIDs). You may not know it but you probably have taken NSAIDs at least once in your life. NSAIDs are widely used both as over-the-counter (OTC) and prescription drugs. Do the names aspirin, ibuprofen and rofecoxib ring a bell? Well, these are the most well-known NSAIDs.

NSAIDs are supposed to be safe and non-addictive with very few side effects. Until the results of this Danish study was published recently that reported that short-term use of NSAIDs can increase the risk for stroke, especially ischemic stroke, even among those without any history of cardiovascular disease. The study was presented at theEuropean Society of Cardiology (ESC) 2010 Congress last week.

According to study author Dr. Gunnar Gislason:

“First we found an increased risk of MI with NSAIDs. Now we are finding the same thing for stroke. This is very serious, as these drugs are very widely used, with many available over the counter. We need to get the message out to healthcare authorities that these drugs need to be regulated more carefully.”

The NSAIDs analyzed in the study were ibuprofen, diclofenac, naproxen, celecoxib and rofecoxib. Most of these are used as analgesics and anti-inflammatory agents. Diclofenac (86%) was associated with the highest increase in stroke risk, followed by celecoxib whereas ibuprofen was associated with lowest but still significant increase in risk (30%) among the drugs analyzed. The study participants were healthy individuals who did not have underlying cardiovascular problems.

So how do NSAIDs increased cardiovascular risk?

There have been several hypotheses about the mechanism linking NSAIDs with cardiovascular events, including increased thrombotic effect on platelets, the endothelium, and/or atherosclerotic plaques; increasing blood pressure; and effect on the kidneys and salt retention.

The authors believe that the results of their have “massive public-health implications”. However, it is unlike that the use of NSAIDs will decrease any time soon because even health care professionals are reluctant to limit prescription of these drugs.

“The problem is that we don’t have randomized trials, and it is very hard to change the habits of doctors. They have been using these drugs for decades without thinking about cardiovascular side effects.” says Dr. Gislason, whose group was able to convince Danish health authorities to declare diclofenac as a prescription-only drug. However, diclofenac and other NSAIDs are available as TOC drugs in many countries.