COMMON painkillers taken daily by hundreds of thousands of arthritis patients significantly increase their risk of having a heart attack.

The shock results of a trial show that all drugs prescribed for the control of pain and inflammation carry similar heart risks.

This means that 400,000 patients in Britain who were switched from the drug Vioxx (rofecoxib) last September when its heart risks came to light may be worse off, depending on which alternative their doctor prescribed. The trial, using data from GPs across Britain, indicates that all drugs classed as non-steroidal anti-inflammatory drugs (NSAIDs) increase the risk of heart attack by at least 20 per cent, and some by as much as 50 per cent.

The class includes ibuprofen, which is bought over the counter, the prescription drugs diclofenac and naproxen, as well as newer and purportedly better treatments such as Celebrex (celecoxib).

Arthritis Care said that it was concerned about the findings and urged patients prescribed any of these drugs to consult their doctor.

The study applies to long-term use of the drugs, not occasional use to treat headaches. The results of the study, by Julia Hippisley-Cox and Carol Coupland, from Nottingham University, published in British Medical Journal, indicate that all the drugs increased heart attack risk when taken in the three months before the attack: Vioxx by 32 per cent, Celebrex by 31 per cent, ibuprofen by 24 per cent, diclofenac by 55 per cent and naproxen by 27 per cent.

Other drugs in the Vioxx class, which are known as COX-2 inhibitors, increased risks by 27 per cent, while other older NSAIDs increased risks by 21 per cent.

“Our study offers no reassurance that the increased risk of myocardial infarction (heart attack) is specific to rofecoxib alone or specific to COX-2 inhibitors,” the report said. “We think that enough concerns exist to warrant a reconsideration of the safety of all NSAIDs.”

The older drugs — ibuprofen, naproxen and diclofenac — have been around for so long that all are out of patent. Some earlier studies have suggested that they increase heart attack risks but this has been overlooked because they cause the more serious side-effects of bleeding in the stomach or the development of ulcers.

Because aspirin, a closely related drug, reduces the risks of heart attacks, NSAIDs had been felt by many to have a neutral or even beneficial effect on the heart.

The study is not conclusive, though, because observational studies that compare cases with controls are liable to error.

An editorial in BMJ by Peter Juni and Stephan Reichenbach, of the University of Berne, and visiting professor Matthias Egger, of the University of Bristol, urged caution in interpreting the study and suggested that large clinical trials may be required ultimately to “establish the best and safest treatment for patients with musculoskeletal pain”.

The message for arthritis sufferers is that there is no perfectly safe drug to control their pain. But Celebrex emerges as well as any other and, given that it has lower ulcer risks than traditional NSAIDs, may remain the choice for many doctors.

Neil Betteridge, the chief executive of Arthritis Care, said: “We urgently need the medical profession to take a lead in helping people with arthritis decide what treatment is right for them.”

Peter Weissberg, the medical director of the British Heart Foundation, said: “It would be wrong to change clinical practice on the basis of current evidence, but it is important we build on this work and address the question in properly constructed and controlled trials.

“For now, any patients who are prescribed NSAIDs should be reassured that the results indicated a very low incidence of heart attack. These people may consider the slight increased risk to be acceptable when offset against welcome pain relief.”

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