Heart Pains

The British Medical Journal last week reported that all the popular painkillers increase the risk of heart attack. But while the headlines emphasized that increased heart attack risk extended to ibuprofen, a close reading of the numbers showed that the "tummy friendly" Vioxx was worse.

An excellent BBC report on the study put the risk in relative terms: For every 1,005 persons taking ibuprofen, the researchers found one additional heart attack (over the expected level). For every 695 persons taking Vioxx, there was one additional heart attack.

The worst drug among the painkillers was diclofenac (sold as Voltaren), which gave one additional person a heart attack for every 521 persons on the drug. The study didn't look at naproxen (sold as Aleve), but the earliest trials comparing it to Vioxx showed it had a significantly lower heart attack risk profile. Celebrex, the only major Cox-2 still on the market, was slightly better than ibuprofen (in terms of heart attack risk) but not as good as naproxen or plain old aspirin, which studies have shown to be cardio-protective.

The study didn't review ulcer risk from taking painkillers (the ostensible reason for taking Cox-2s over the generics like ibuprofen in the first place). But previous studies have indicated that the risk of getting ulcers from taking traditional painkillers is about the same as suffering a heart attack from taking those drugs.

Bottom line: Most of these drugs offer about the same pain relief. The increased risk of heart attack from taking any of these drugs is low. But some are safer than others and in the absence of any additional pain relief or even with a small reduction in an already small risk of ulcers (which is much easier to treat than a heart attack), it makes no sense for people to be taking the less safe ones like Vioxx.

The media could do the public a huge favor by sorting out the various risk profiles of these commonly prescribed and purchased medicines.