NSAIDs May Affect the Risk of Stroke

I don’t usually pay too much attention to reports form medical meetings, which haven’t had the benefit of peer-review.  But a report from the European Society of Cardiology meeting in Stockholm caught my eye;  it deals with the occurrence of stroke in people taking a short course of an NSAID (non-steroid anti-inflammatory drug) – is there an increased risk? 

The health system in Denmark provides an ideal source for data on associations between prescription drug usage and adverse events, such as death or hospitalization.  Using this system, in 2008 the authors of the present study showed an association between NSAIDs and the occurrence of a repeat heart attack. 

The study population was drawn from the entire Danish population over 10 years of age.  Anyone admitted to hospital within the previous 5 years or those prescribed medications for chronic conditions were excluded, to provide a ‘healthy’ study population of about 500,000.

Analysis showed 45% of the study subjects had been given a prescription for an NSAID between 1997 and 2005.  Hospitalization for stroke data and death registries allowed estimates of the risk of fatal and non-fatal stroke associated with the use of NSAIDs.  The increased risk of stroke ranged from 30% for ibuprophen (Advil®) and naproxen (Aleve®) to 86% with diclofenac (Voltaren®).  A dose-dependent effect was seen with ibuprophen; the risk was increased 28% at does up to 200 mg, and reached 90% with doses higher than 200 mg.

One should note that there are many more NSAIDs available over-the-counter in the USA than in Denmark.  There should be an attempt made to see if similar relationships exist between NSAID usage in the USA and an increased risk of heart attack or stroke.  Such a study would be extremely difficult to design and carry out, but it seems important enough to attract the attention of FDA.  It ought to be possible to use medical records (think Kaiser Permanente) to search for an 80% increased risk of stroke or heart attack in people prescribed high doses of such analgesics . . .  In the meantime, we can try not to take more than maximum recommended doses and obey the frequency limitations given in the package inserts.