So Why Is The Cardiovascular Connection Unexpected?

The two withdrawn NSAIDs are known as ‘coxibs’ and they belong to a class of medications known as cyclo-oxygenase 2 (COX-2) inhibitors. So the risk of cardiovascular side effects was originally just associated with these particular drugs. But diclofenac and ibuprofen are in a slightly different class, so the latest research shows that a wider group of NSAIDs are associated with cardiovascular risks.

How do NSAIDS work and what is the significance of COX-1 and 2?

NSAIDs prevent the production of substances called prostaglandins which are released when the body is injured or in response to diseases such as arthritis.  

There are two pathways in the production of prostaglandins, which are controlled by production of COX-1 and COX-2 enzymes. 

The earliest NSAIDS (such as ibuprofen and diclofenac) inhibited both types of COX enzymes and because of their effect on COX-1 enzymes they are associated with adverse effects in the digestive tract.  These effects include ulceration (wearing away of the gut lining) and bleeding from ulcers.  As a result, NSAIDs which were selective and only blocked COX-2 enzymes, were developed. 

This was thought to be a significant step forward at the time (the 1990s) because these selective COX-2 inhibitors were as effective in relieving pain and inflammation as the non-selective earlier ones. But they were not as bad as the typical NSAID for causing side effects affecting the digestive tract.  However as mentioned, they later became associated with cardiovascular disease instead.

Should I stop taking NSAIDs like ibuprofen for aches and pains?

The latest study was of high-doses of NSAIDs prescribed by doctors.

Also, the study was of people who took these drugs long-term i.e. every day for a year or more.  Taking the occasional ibuprofen tablet for headache or joint pains does not involve the same risks.

What should people who take long-term high-dose NSAIDs do?

Talk to their doctor. One conclusion of the study was that the risk of serious side effects from these drugs is predictable. This will enable doctors and patients to weigh up the potential hazards against the benefits of effective long-term pain relief.

What alternatives are there to high-dose NSAIDs?

Naproxen - the only NSAID studied which wasn’t associated with cardiovascular risks. 

Other classes of painkillers, which are not NSAIDS, include opiates which are related to morphine.  They include codeine, which is available as a single agent in various strengths, or also combined with other painkillers. A combination of acetominophen (paracetamol) with codeine is known in some places as co-codamol, and co-dydramol is paracetamol with dihydrocodeine. 

For this reason most opiate drugs are not available without a prescription.

If you are at all concerned about risks associated with medication you are taking, speak to your doctor or a pharmacist.