Older Australians face an increased risk of stroke when taking prescription NSAIDs, research finds.
The risk of stroke almost doubled among people who had recently been dispensed any NSAID for the first time, according to the study of more than 160,000 Australian veterans.
The researchers found NSAIDs could be responsible for 13 strokes per 1000 people taking the drugs each year.
Writing in the Medical Journal of Australia, they said initiation of NSAIDs was linked with an increased risk of incident stroke, including ischaemic and haemorrhagic, among Australian veterans.
“However, the absolute risk of stroke is low and the increased risk is thus small,” said the researchers, from the University of South Australia’s Sansom Institute.
“Nevertheless, small increases in risk may be particularly important for older people, who commonly have comorbidities that are associated with increased risk of stroke.
Diclofenac, meloxicam and celecoxib, which accounted for almost two-thirds of NSAID scripts in Australia in 2008, were all significantly associated with increased stroke risk, the researchers found.
The increased stroke risk with diclofenac was on a par with rofecoxib (Vioxx), which was withdrawn in 2004.
Of the individual NSAIDs, only ibuprofen was not linked with increased risk of stroke.
The study included data on 162,065 veterans who had been dispensed an NSAID between January 2001 and
December 2008.
Medicine industry group the Australian Self-Medication Industry noted that the study included only prescriptions, and was unable to examine the over-the-counter use of NSAIDs.
“Generally speaking, OTC NSAIDs are safe and effective for the temporary relief of pain and inflammation,” the group said in a statement today.
The latest study follows a recent paper reporting that naproxen and low-dose ibuprofen were the “safer” NSAIDs in terms of cardiovascular risk. (http://www.australiandoctor.com.au/articles/17/0c072f17.asp )
Reviewing data from more than 2.7 million people, researchers found those taking naproxen faced a 9% increased risk and those on low-dose ibuprofen had an 18% increased risk of major cardiovascular events, compared with individuals not taking NSAIDs. Rofecoxib was associated with the highest increased cardiovascular risk of 45% over unexposed patients, followed by diclofenac at 40%, the study found.
MJA 2011; 195:525-529
http://www.mja.com.au/public/issues/195_09_071111/cau10055_fm.html