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Ibuprofen-like painkillers linked to an increased risk of heart failure

Thu, 2016-09-29 09:30

"Ibuprofen could raise the risk of heart failure by up to 83%," claims the Daily Mirror. But this headline massively overstates the danger of this painkiller.

In fact, new research suggests that taking painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs) – which includes ibuprofen – increases the risk of heart failure by less than 20% overall.

NSAIDs are a group of painkilling medicines commonly taken by people with joint problems, backache and arthritis. They are prescribed to relieve pain and reduce inflammation.

The study found that the risk of heart failure varies between NSAIDs and according to dosage.

While a rarely prescribed NSAID called ketorolac almost doubled the risk of heart problems, the more commonly taken ibuprofen increased the chance of heart problems by just 18%.

The risk was also highest for people who took an NSAID on a daily basis and in very high doses.

Some NSAIDs, such as ketoprofen and celecoxib, did not seem to increase the risk at all at usual doses.

This latest study backs up previous evidence that NSAIDs are clearly linked with an increased risk of heart failure. But it's important to bear in mind that the risk is, for most people, still very small.

Heart failure is caused by a wide range of conditions, including high blood pressure, heart attacks and obesity.

Where did the story come from?

This was a large study involving more than 7 million people. It was carried out by researchers from seven European institutions, led by the University of Milan, and was funded by the European Union. The study was published in the peer-reviewed British Medical Journal (BMJ).

Some UK media outlets failed to make it clear the study was carried out among people who were taking prescribed NSAIDs, usually for a long-term condition such as backache or arthritis, rather than people taking the occasional over-the-counter painkiller.

The Daily Express headline wrongly says: "Over-the-counter painkillers raise risk by almost 20%," although at least they used the more credible 20% relative risk figure.

The Daily Mirror's scaremongering headline stating an increased risk of heart failure of 83% was way above that of most of the NSAIDs studied and was wrongly linked to ibuprofen.

BBC News took a more balanced view, and included interviews with experts who discussed exactly who is and isn't at risk from NSAIDs and heart failure.

What kind of research was this?

This was a so-called nested case-control study, which used drug databases to identify people who'd been prescribed NSAIDs during a 10 year period. Of these, those who had been admitted to hospital for heart failure were compared with others in the database of the same age and sex.

This type of study helps researchers identify links between individual drugs and outcomes such as heart disease. They don't directly prove the drug causes the heart disease, but we've already seen randomised controlled trials showing NSAIDs in general do seem to raise the chances of heart failure.

What did the research involve?

Researchers used five drug databases from four European countries to identify adults who'd had at least one NSAID prescription between 2000 and 2010. They then identified anyone from that group who'd later been admitted to hospital with heart failure and matched them with up to 100 "controls" – people the same age and sex, who'd started the study around the same time.

They then looked to see whether a current prescription of an NSAID (within the last 14 days) affected someone's chances of being admitted to hospital with heart failure.

The databases were from the UK, Italy, the Netherlands and Germany. For the UK and the Netherlands, the databases also recorded the daily dose prescribed, so the researchers used this information to calculate the effect of low, normal, high or very high prescribed doses.

The researchers corrected their figures to take account of factors such as previous diagnosis of heart failure or other medical condition and other medicines being taken.

What were the basic results?

The study found 92,163 people who'd been admitted to hospital with heart failure among the 7.6 million people prescribed an NSAID who were included in the study. People admitted with heart failure tended to be older, with an average age of 77, and many of them also had high blood pressure, high cholesterol, cardiovascular disease or diabetes.

Compared to others of about the same age and sex, those who'd been admitted for heart failure were more likely to be currently taking a prescribed NSAID.

In fact, nearly one in five (17.4 %) of heart failure patients and one in seven (14.4 %) of the matched control groups had a current prescription. This meant that having a current prescription for any NSAID raised the risk of heart failure admission by almost 20% (odds ratio (OR) 1.19, 95% confidence interval (CI) 1.17 to 1.22).

However, more interesting was the information about individual drugs. Nine NSAIDs had a raised risk of heart failure: ketorolac, etoricoxib, indomethacin, rofecoxib, piroxicam, diclofenac, nimeluside, ibuprofen and naproxen.

The degree of increased relative risk varied between them, from ketorolac at 83% to naproxen at 16%.

Some of the NSAIDs, including the commonly used ketoprofen and celeocoxib, did not show any increased risk.

The risk was highest for people taking very high daily doses (twice the usual daily dose) of NSAIDs.

How did the researchers interpret the results?

The researchers said their study results showed that the risk of heart failure in people taking NSAIDs "appears to vary between individual NSAIDs, and is dose dependent". 

They say their findings "might apply to NSAIDs obtained over the counter", although they only looked at prescription drugs.

"Although over-the-counter NSAIDs are probably typically used at lower doses, by younger people, and for shorter durations than prescribed NSAIDs, they are sometimes available at the same doses," they observe, adding "they may be inappropriately over-used".

They call for research into the safety of over-the-counter NSAIDs "under the conditions they are typically used".

Conclusion

This useful and well-conducted study isn't the first to say NSAIDs may raise the risk of heart failure. We've known for some time that NSAIDs can have side effects, especially when used at high doses and for long periods.

What this study does help show is the different levels of risk between different NSAIDs, and confirms that the risk depends partly on the dose. It's important to remember that the study only included people who were prescribed NSAIDs and not people who'd bought them over the counter.

The information is most useful to older people taking prescribed NSAIDs long-term for conditions such as gout or arthritis. These are the people most likely to be affected by heart problems linked to NSAIDs.

The study shows that some NSAIDs are less risky than others, and doctors can use this information to discuss with patients which is the most suitable drug if they need long-term anti-inflammatory painkillers.

For people who take NSAIDs over the counter, it's a reminder that these drugs are not risk-free. While an otherwise healtlhy 20-something taking ibuprofen for a day or two to get over backache is highly unlikely to get heart failure as a result, long-term use of NSAIDs at high doses can cause problems.

Sensible advice is to take the lowest dose that works for the shortest period you need it. If you find you need to take NSAIDs very often, or you're taking doses higher than those recommended, you should talk to your doctor about your pain.

Find out more about living with pain.

Links To The Headlines

Ibuprofen link to heart failure: Over-the-counter painkillers raise risk by almost 20%. The Daily Express, September 29 2016

Ibuprofen increases heart risk by a fifth. The Times, September 29 2016

Common painkillers 'increase heart failure risk'. BBC News, September 29 2016

Painkillers like ibuprofen may raise risk of hospital admission for heart failure. The Telegraph, September 29 2016

Links To Science

Corrao G, Arfe A, Scotti L et al. Non-steroidal anti-inflammatory drugs and risk of heart failure in four European countries: nested case control study. The British Medical Journal. Published Online 28 September 2016

Categories: News

Acne won't extend your life, but might delay signs of ageing

Wed, 2016-09-28 07:00

"Spotty teenagers may have the last laugh over their peers with perfect skin after research found that those who suffer from acne are likely to live longer," says The Telegraph online.

But the report misunderstands the research findings, which were related to cell ageing, not length of life.

The researchers state dermatologists have for many years noticed that people who have had acne show signs of ageing later than those who have never had the skin condition.

Signs of ageing are cited as the appearance of wrinkles and thinning of the skin. This new study looked at why that might be. 

The researchers found, by analysing white blood cells, that women who said they'd had acne had longer telomeres, the "caps" at the end of chromosomes.

Cells replicate repeatedly, and telomeres are thought to protect them from deterioration as a result of this process. The Telegraph likened these caps to the hard tips on shoelaces that prevent fraying.

While this study doesn't show that telomere length is a cause of acne, it shows there may be a link between the two.

However, the study didn't look at whether the women with longer telomeres had fewer signs of skin ageing, or whether they lived longer. The suggestion that acne could affect how long you live is therefore unfounded.

Where did the story come from?

The study was carried out by researchers from King's College London and New Jersey Medical School, and was funded by the Wellcome Trust, the Medical Research Council, the European Union and the National Institute for Health Research. 

The study was published in the peer-reviewed Journal of Investigative Dermatology.

Mail Online, ITV News, The Daily Telegraph and BBC newsbeat got the thrust of the story right: that acne is linked to longer telomeres, which may explain why some people who've had acne have younger-looking skin as they get older.

Only The Telegraph online suggested acne could help you live longer. This idea is not mentioned in the study or in the press release from the authors.

What kind of research was this?

This study used two methods: a cohort study and a case control study

Researchers took a group of women, identified those who reported having acne at some point in their lives, and compared the length of telomeres taken from their white blood cells with telomeres from women who said they'd never had acne.

They also carried out a case control study comparing gene expression in women who'd had acne with women the same age who had not reported having ever had the skin condition.

This type of research can start to identify links between factors such as telomere length and acne, but can't prove that one causes the other.

What did the research involve?

Researchers recruited 1,205 volunteers from TwinsUK, a registry of 12,000 twins used to study the genetic and environmental causes of age-related traits and diseases. The registry involves mainly women, so men were excluded from the study.

Researchers who are interested in the genetic basis of conditions often work with twins, as it helps identify which factors are down to environment and which are down to a shared genetic profile.

Researchers asked the participants if they had ever had acne. Participants provided samples of white blood cells, which were then analysed for telomere length.

After adjusting their figures for age, twin relationships, weight and height, the researchers compared average telomere length between the two groups.

Separately from the telomere study, researchers age-matched 195 twins without acne to 39 twins with acne, took skin biopsies, and used their whole genome data to compare gene expression – whether a gene is "switched on" or not – between the groups.

What were the basic results?

Women who'd had acne had, on average, longer telomeres (mean 7.17 +/- 0.64 kilobases [kb]) than women who'd not had acne (mean 6.92+/- 0.02kb) after the figures had been adjusted for the women's age, weight and height.

Telomere lengths are calculated in kilobases, referring to the number of six base-pair sequences of DNA found in telomeres.

Only one gene (ZNF420) was more commonly expressed in women without acne than women who'd had acne.

How did the researchers interpret the results?

The researchers say longer telomeres in women who've had acne suggest that "delayed skin ageing may be due to reduced senescence" – in other words, skin ageing may be delayed because the longer telomeres in the cells protect them from deterioration.

They go on to say the reduced expression of the regulatory gene ZNF420 in people with acne suggests these people may produce more of a particular protein linked to that gene.

Conclusion

Acne can be very distressing for teenagers and those who get it later in life. It may be some comfort to know that people with acne tend to show fewer signs of skin ageing, such as wrinkles and thin skin, when they get older.

The link between telomere length and acne is interesting for researchers, but doesn't mean that much for the rest of us.

It may be part of the explanation for slower skin ageing in people who've had acne. And it adds weight to the theory that there's a genetic component to acne.

But the study doesn't tell us whether people who'd had acne and had longer telomeres actually had younger-looking skin.

The article was published as a letter to the editor and is much shorter than most research articles, so does not give us a lot of information about how the study was carried out.

The study only included women, so we don't know if it would also apply to men. And it also relied on women saying they'd had acne, rather than on a medical diagnosis, so there may be some variation in whether women thought they'd had acne or not.

If you're concerned about acne, there are plenty of self-help methods you can try, or you can talk to a pharmacist for advice on over-the-counter treatments.

If it's making you very unhappy and these methods aren't working, talk to your GP.

Find out more about acne and how to treat it

Links To The Headlines

Acne sufferers live longer, research suggests. The Telegraph, September 28 2016

Why being a spotty teenager stops your skin ageing: Acne sufferers' cells have built-in protection that keeps them looking younger. Mail Online, September 28 2016

Teens with spots tend to stay looking younger for longer, new research suggests. BBC newsbeat, September 28 2016

Acne sufferers stay youthful-looking for longer. ITV News, September 28 2016

Links To Science

Ribero S, Sanna M, Visconti A, et al. Acne and telomere length, a new spectrum between senescence and apoptosis pathways. The Journal of Investigative Dermatology. Published online September 2016.

 

Categories: News