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NSAIDs ‘associated with increased CVD risk’

GPs are bracing themselves for a deluge of enquiries after national media reported a study that showed NSAIDs can increase the risk of heart attack or stroke by a third.

Both today's Daily Mail and Telegraph carried stories on a UK systematic review that examined data from 51 large scale studies conducted in Europe, USA, Canada and Australia.

The study - published in PLoS Medicine this week - showed in patients with heart problems, or those with cardiovascular risk factors, use of NSAIDs including diclofenac and indomethacin was significantly associated with an increase in the risk of serious cardiovascular events such as heart attack and stroke.

Other common NSAIDs, including naproxen and low doses of ibuprofen do not appear to be associated with an increase in risk.

The researchers from Hull York Medical School and the Institute for Clinical Evaluative Sciences in Canada said their data could be used to evaluate the benefit versus harm for individual NSAIDs.

Lead researcher Dr Patricia McGettigan said: 'For the first time, we have enough data to make direct comparisons between NSAIDs to determine which are most risky and which are relatively safe.'

‘For example, diclofenac, the NSAID most commonly prescribed in England in 2010, was associated with an increase in cardiovascular risk of 40% (compared with non-use).'

‘At high doses, the increase in risk was almost doubled. An alternative, naproxen, prescribed only half as often, was not associated with increased risk at any dose.'

The Mail quotes the Medicines and Healthcare Regulatory Agency as saying that patients should not stop taking their drugs, but should consult their doctor if they have fears over its safety.

BMA Council and GPC member Dr Helena McKeown told Pulse that the way the news was handled meant that GPs would face huge pressure as worried patients called for reassurance.

The Salisbury GP said: ‘Yet again GPs wake up to hear on [BBC Radio 4's] Today programme that concerned, often stable patients will be requesting face-to-face or telephone consultations about their medication.'

Dr McKeown suggested that news of this kind should be handled more responsibly in co-operation with GPs.

‘Surely it must be possible that GPs have appropriate forewarning of such press releases to the media and a chance for respected GP voices to balance the news at the same time that the media report it? I would like the chance for practices to be proactive with, for example an information sheet that receptionists might hand out and a posting on our websites,' she said.

Last year 17 million prescriptions for NSAIDs were written by GPs in England alone and many of the drugs are also available over the counter.


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