The drugs, known as non-steroidal anti-inflammatory drugs (NSAIDs), include ibuprofen and diclofenac, and also newer medication called coxibs. They are used by people with arthritis and other forms of chronic pain.
For every 1,000 people with a moderate risk of heart disease taking them for one year, three extra people would have an avoidable heart attack including one death.
The study found naproxen was the safest NSAID. Researchers looked at the highest doses of painkillers prescribed by doctors, twice the daily amount recommended for headache and other minor ailments.
They said a short course of tablets bought over the counter for a muscle sprain was unlikely to be hazardous. The study pooled the findings from 639 trials involving over 353,000 people after numerous small trials showed a link between NSAIDs and heart side effects.
Study leader Professor Colin Baigent, of the Medical Research Council Clinical Trial Service Unit & Epidemiological Studies Unit at Oxford University, said the results would help patients to balance the benefits and risks of using the drugs, and that they should not panic.
He said: “We’re talking about really low risks. The extra risk of a heart attack is very small. But if patients are worried they could talk to their GP about it and they can consider if the risks, which are real but small, are worth it for them.”
At least seven million Britons with arthritis take painkillers, including NSAIDs such as ibuprofen, diclofenac and coxibs.
The research found for every 1,000 people with a moderate risk of heart disease having one year of treatment with high-dose diclofenac (150mg daily) or ibuprofen (2400 mg daily), about three would experience an avoidable heart attack, of which one would be fatal.
In contrast, high doses of naproxen did not affect heart attack risk, said the study published in The Lancet medical journal.
However, like other NSAIDs it was linked with a doubling of heart failure risk and a two-to-fourfold higher risk of bleeding stomach ulcers. Arthritis experts stressed that the drugs brought relief to millions, with many unable to lead a normal life without them.
There were 17million prescriptions for NSAIDs in 2010, including one-third diclofenac, one-third ibuprofen and one-sixth naproxen.
The safety of diclofenac is being investigated by a Europe-wide review due to report next month.
Almost ten years ago the anti- arthritis drug Vioxx was voluntarily taken off the market because of an increased risk of heart attacks and strokes – of a similar magnitude to the findings in the latest study.
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