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All non-aspirin NSAIDs appear to increase the risk of heart attacks and need to be assessed for their cardiovascular safety, a major new study concludes.

The analysis of more than 110,000 patients found nap-roxen and other conventional non-aspirin NSAIDs posed as large a cardiovascular risk as cox-2 inhibitors.

GP rheumatology experts called for better information from the regulatory authorities on the risk from NSAIDs and urged caution in use of the drugs in patients with cardiovascular disease.

Study leader Dr Soren Johnsen, associate professor of clinical epidemiology at Aar-hus University Hospital in Denmark, said he had been 'surprised' by the findings and called for a regulatory review of all NSAIDs.

He warned: 'These drugs should only be used when there is a real indication. We should be cautious about using even these well-established drugs.'

The study analysed users of conventional NSAIDs and cox-2 inhibitors in 10,280 cases of first-time hospital admission for MI and 102,797 matched controls.

Compared with non-users, current use of naproxen increased risk by 50 per cent, and other non-aspirin conventional NSAIDs by 68 per cent.

Celecoxib increased risk by 25 per cent, rofecoxib, now withdrawn after safety fears, by 80 per cent, and other cox-2s by 45 per cent.

Dr Iain Gilchrist, member of the Primary Care Rheumatology Society and a GP in Hatfield Heath, Essex, said: 'We ought to be warning patients that there is an increased risk from NSAIDs.

'If the regulatory authorities would provide us with

that information in an easily understandable way it would help.'

Dr Peter Stott, a GP with a special interest in rheumatology in Tadworth, Surrey, said: 'It does show there is scope for further research.

'GPs should evaluate all patients on NSAIDs and cox-2s if they have cardiovascular risk.'

The Medicines and Healthcare Products Regulatory Agency is currently analysing the risks and benefits of cox-2s and has said it will also scrutinise the safety of conventional NSAIDs.

The study, in this week's Archives of Internal Medicine, adjusted risk estimates for a range of factors including history of cardiovascular disease.

By Nerys Hairon

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