It never rains but it pours and, this time, the deluge in the medical press covers the use of non-aspirin non-steroidal anti-inflammatory drugs, or NANSAIDs, both as a treatment for coronary heart disease (CHD) and as a cause of ulcers.

This damning report followed more than 180,000 individuals for 11 years. The researchers compared the incidence of serious CHD among those who took NANSAIDs ‘just in case’ and those who did not. They found that such NANSAID use had no effect on the risk of serious heart disease.

Given the side-effects of NSAIDS, including gastrointestinal bleeding, dyspepsia, kidney dysfunction, aggravation of hypertension and, in some trials, increased risk of heart failure, the researchers concluded that NANSAIDS should not be used prophylactically in cases of serious CHD (Lancet, 2002; 359: 118-23, 92-3).

* A meta-analysis of the effectiveness of antiplatelet therapies by the Antithrombotic Trialists’ Collaboration reported long-term benefit with aspirin in low doses of 75-150 mg daily.

However, an accompanying report sounded a note of caution, suggesting serious flaws in the method used by the Collaboration and noting that, while aspirin may reduce the incidence of non-fatal events, most trials of aspirin show an increase in death after heart attack.
Also, the long-term use of aspirin is neither cheap nor safe as it is associated with a high rate of GI bleeding and kidney failure, both of which can be costly to treat (BMJ, 2002; 324: 71-86, 103-5).

* NSAIDs took a further blow with the results of two other studies.

A meta-analysis by Canadian researchers found that peptic ulcers were more common among those with Helicobacter pylori infection than in those without it. In an analysis of case studies, they also found that infected NSAID takers were six times more likely to have a peptic ulcer than non-infected takers (Lancet, 2002; 359: 14-22).

In the second study, Hong Kong researchers looked at arthritis patients who are conventionally given NSAID treatment. Before prescribing this treatment, patients were screened for H. pylori.

Half of those with H. pylori were given antibacterial treatment while half were given a placebo. The patients were then given the NSAID diclofenac for six months. The untreated group had a three-fold greater incidence of peptic ulcers than those who were treated (Lancet, 2002; 359: 9-13).