With New Link to A-Fib, NSAIDs Can’t
Get a Break

The safety of NSAIDs has been a subject of debate since at least 10 years ago when Vioxx was pulled from shelves following revelations that it increased risk of myocardial infarction. In the last issue of Running & FitNews® we reported new meta-analysis data that recommended naproxen, long thought to be among the safest of the NSAIDs on the market, back away from its claims that its risk of cardiovascular events was lower than other COX-2 inhibitors.

Now, a prospective study published in BMJ Open has found that NSAID use among the elderly is associated with increased risk of atrial fibrillation. The condition, also known as a-fib, is a somewhat common type of abnormal heartbeat during which heart rhythm is fast and irregular. The study looked at a Dutch cohort of 8,400 people over 13 years, data for which was originally collected to look into factors influencing disease onset in older people. None of the subjects had a-fib at baseline (age 69 years).

Atrial fibrillation was ascertained from ECG assessments as well as medical records. Use of NSAIDs was obtained from automated prescription records by linkage with participating pharmacies. During a mean follow-up of 13 years, 857 participants developed atrial fibrillation. Adjustments were made for age, sex and several potential confounders.

NSAIDs used currently for 15 to 30 days were associated with higher a-fib risk relative to “never use.” Use within the past 30 days (“recent past”) also brought increased risk. The authors speculate that, in addition to possible effects on blood pressure, NSAIDs could cause fluctuations in serum potassium, possibly contributing to atrial fibrillation. Further studies are needed to investigate the underlying mechanisms behind this association of increased a-fib risk with NSAID use in older populations.

In addition to older sedentary populations, many runners young and old use NSAIDs routinely to reduce pain and muscle soreness. NSAIDs, including ibuprofen, treat fever and pain but reduce the inflammatory response, thinning the blood. The most common side effect of ibuprofen use in athletes is therefore GI damage because they can aggravate exercise-induced small intestinal injury and induce gut barrier dysfunction. Everyone, then, should be aware that prolonged NSAID consumption is not harmless and should be discouraged.

And finally, do note that many people may have some form of a-fib but may not be aware of an abnormal heartbeat. Be aware that symptoms can start or stop suddenly because atrial fibrillation may stop or start on its own. If you suspect you might have an irregular heartbeat, even occasionally, look for these symptoms from the National Center for Biotechnology Information:

  • Pulse that feels rapid, racing, pounding, fluttering, irregular or too slow
  • Sensation of feeling the heartbeat (palpitations)
  • Confusion
  • Dizziness, light-headedness
  • Fainting
  • Fatigue
  • Loss of ability to exercise
  • Shortness of breath

See a doctor if you experience any of these symptoms. Your doctor may be able to detect a fast heartbeat while listening through a stethoscope. A heart rate in the 60 to 100 bpm range is considered normal. In atrial fibrillation/flutter, your heart rate may be more like 100 to 175. Blood pressure may be either normal or low. An ECG may be ordered to see if a-fib is present.

BMJ Open, 2014, doi:10.1136/bmjopen-2013-004059,
http://bmjopen.bmj.com/content/4/4/e004059

NEJM Journal Watch, Feb. 2014, http://www.jwatch.org/fw108472/2014/02/12/fda-advisers-
meta-analysis-does-not-prove-naproxen?query=pfw

National Library of Medicine, May 2013, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001236/#adam_000184.disease.prognosis

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