Common painkillers that have been linked to an increased risk of heart attack may also elevate risk of stroke

Researchers found that among nearly 38,000 Taiwanese adults who suffered a stroke over one year, the use of a non-steroidal anti-inflammatory drug (NSAID) in the prior month may have elevated their stroke risk.

The increases linked to individual NSAIDs were generally modest, the investigators report in the medical journal Stroke. And the findings do not prove that the medications themselves led to some people's strokes.

NSAIDs are a group of painkillers that include over-the-counter medications like aspirin, ibuprofen (Advil, Motrin and other brands) and naproxen (Aleve), as well as prescription arthritis drugs known as COX-2 inhibitors.

The COX-2 inhibitors were first linked to an increased risk of heart attack and other cardiovascular problems, and two of the drugs -- rofecoxib (Vioxx) and valdecoxib (Bextra) -- were pulled from the market in 2004 and 2005, respectively; a third COX-2 inhibitor, celecoxib (Celebrex) remains on the market.

But subsequent studies also raised concerns about the possible heart risks of some of the older, over-the-counter NSAIDs, including ibuprofen and diclofenac (Voltaren).

These latest findings suggest that the "concern may also extend to the risk of stroke," said Dr. Elliott Antman, a professor of medicine at Harvard Medical School and Brigham and Women's Hospital in Boston who was not involved in the study.

The new results do underscore the general recommendation that, to limit any cardiovascular risks, people should use NSAIDs at the lowest dose and for the shortest time necessary to relieve their pain, added Antman, who is also a spokesman for the American Heart Association (AHA).

For the current study, researchers led by Dr. Chia-Hsuin Chang of National Taiwan University Hospital used information from Taiwan's national health insurance database. They identified nearly 38,000 adults age 20 or older who had suffered a stroke in 2006, then looked at the patients' NSAID use in the month before the stroke and compared it to use in the prior three to six months.

The specific medications included celecoxib, ibuprofen, naproxen, diclofenac and other oral NSAIDs, as well as ones sometimes given by IV or injection, such as ketorolac (Toradol).

In general, the study found that use of any NSAID in the 30 days before the stroke was linked to an increased risk -- of anywhere from 20 percent to 90 percent for most of the oral NSAIDs, depending on the drug. Oral ketorolac was linked to the greatest risk increase of 2.6-fold.

Antman urged caution in interpreting the last result because it was based on a small number of patients: only 131 had used oral ketorolac in the month before their strokes.

The pattern was seen in patients with cardiovascular risk factors and those without, the researchers say.

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