NSAIDs May Increase Heart Attack Risk

Patients with a respiratory illness treated with intravenous nonsteroidal anti-inflammatory drugs had a 7.2 times greater risk of heart attack.

A new study indicates that taking popular pain relievers during a cold or flu-like illness could result in a heart attack. Due to these findings, physicians and patients should be cautious when prescribing or taking nonsteroidal anti-inflammatory drugs (NSAIDs) for the treatment of an acute respiratory infection, according to a study published by the Journal of Infectious Diseases.

In the study, the authors analyzed claims for 10,000 patients who were hospitalized for a heart attack between 2005 to 2011. The investigators evaluated whether an acute respiratory infection combined with NSAID use had a joint impact on heart attack risk.

Each patient’s risk for heart attack was evaluated over time, including periods of respiratory illness and NSAID use. Interestingly, the risk of heart attack was observed to be higher when patients were using NSAIDs to treat a respiratory infection.

The researchers found that NSAID use for a respiratory infection increased the risk of experiencing a heart attack 3.4-fold. Patients administered the medication intravenously in a hospital had a 7.2 times greater risk of heart attack, compared with when the patients were not ill or taking NSAIDs, according to the study.

When not taking NSAIDs, patients with an acute respiratory illness were 2.7 times more likely to experience a heart attack. The investigators also found that NSAID use absent of a respiratory infection resulted in a 1.5 times greater risk of heart attack.

Other studies have found a link between NSAIDs and heart problems, but none have analyzed the risk factors together.

"Physicians should be aware that the use of NSAIDs during an acute respiratory infection might further increase the risk of a heart attack," said study author Cheng-Chung Fang, MD.

The investigators suggest that acetaminophen, an alternative pain medication, may be safer for patients experiencing a respiratory illness in terms of cardiovascular risks, according to the study. However, the pain medication was not analyzed in the current study.

The researchers caution that their findings suggest a link between NSAIDs, respiratory infections, and cardiovascular risks, but they do not prove a cause-and-effect association. Further studies are needed to provide additional insights about the cardiovascular risks and how they can be managed.

Other factors, such as safer NSAIDs, how illness severity impacts risks, and whether certain patients are more susceptible, should be examined, according to the study.

In a related commentary, Charlotte Warren-Gash, PhD, MRCP, and Jacob A. Udell, MD, MPH, who were independent of the study, said that the findings suggest a potential trigger for heart attacks, while also underscoring the need for caution NSAIDs use.

"Clinicians should consider both medical conditions and existing medications when prescribing NSAIDs for symptomatic acute respiratory infection relief," the authors wrote.