> Some older, "safe" painkillers appear to cause the same heart problems
> as the much-scrutinized and discredited painkiller Vioxx, according to
> new research, which raises new concerns about the safety of treatments
> for chronic painful conditions such as arthritis.

> At the same time, Vioxx itself appears to have even more side effects
> than previously believed, according to research published on-line
> yesterday by the Journal of the American Medical Association.

> Three articles in JAMA feature some striking conclusions, including:

> Older painkillers such as diclofenac sharply increase the risk of heart
> attacks in regular users.

> Other traditional painkillers including meloxicam, indomethacin and
> perhaps even over-the-counter products such as ibuprofen may also
> increase the risk of heart disease.

> Rofecobix (brand name Vioxx) -- already pulled from the market because
> it increased the risk of heart attacks and stroke -- may also cause
> kidney damage and heart arrhythmia (abnormal heart rhythm).

> Celecoxib (brand name Celebrex) -- which is still available -- may
> cause heart problems, but only when taken at relatively high doses of
> 200 milligrams or more daily.

> The painkiller naproxen does not reduce the risk of cardiovascular
> problems, as previous research has suggested, but it does not cause
> additional risk, either.

> More than 30 million people worldwide take these medications, known as
> non-steroidal anti-inflammatory drugs, for the daily treatment of pain
> and inflammation. So, the potential repercussions of the findings are
> widespread.

> NSAIDs are already known to cause gastrointestinal problems, and adding
> heart problems to the mix could deter patients from their use.

> "It's important not to get too alarmed by these findings," said David
> Juurlink, a scientist at the Toronto-based Institute for Clinical
> Evaluative Sciences.

> He said the news that taking diclofenac can increase risk by 40 per
> cent may alarm some users, but that they need to bear in mind that
> individual risk depends on dose and cardiovascular risk factors.

> "All drugs have risks and benefits and data like this force us to
> scrutinize our behaviour," Dr. Juurlink said.

> One study, led by Jingjung Zhang of Harvard Medical School in Boston,
> looked at the safety of cyclooxygenase 2 (cox-2) inhibitors such as
> Vioxx, Celebrex and valdecoxib (brand name Bextra, it has also been
> withdrawn from the market). The researchers combined the findings of
> 114 studies involving more than 115,000 patients and found that those
> taking Vioxx had markedly higher rates of kidney problems and
> arrhythmia.

> Patients taking the other drugs did not have the same problems, leading
> Dr. Zhang to conclude that there is "no cox-2 inhibitor class effect."

> The second study, led by Patricia McGettigan of the University of
> Newcastle in New South Wales, Australia, examined the cardiovascular
> risks associated with a broad range of painkillers, new and old. The
> review of 17 studies included more than 75,000 patients taking cox-2
> inhibitors and 375,000 taking traditional NSAIDs.

> Patients taking Vioxx saw their risk of heart attack double, while
> those taking diclofenac saw their risk increase 40 per cent. Ibuprofen
> increased risk by 7 per cent, a virtually negligible effect.

> David Graham of the U.S. Food and Drug Administration (but who has
> clashed publicly with his employer about its policies), said in an
> editorial published by JAMA that, for patients with arthritis and other
> chronic conditions that require pain relief "naproxen appears to be the
> safest NSAID choice."

> He said that while the data on Celebrex look relatively good, it is no
> better than traditional NSAIDs, so its use is not justified.