NEW YORK (Reuters Health) - Use of a class of painkillers known as nonsteroidal anti-inflammatory drugs (NSAIDs) by patients with chronic heart failure is associated with increased risk of death and cardiovascular illness, new research suggests.

"Accumulating evidence" points to increased cardiovascular risk associated with NSAID use, in particular in patients with established cardiovascular disease, Dr. Gunnar H. Gislason, of Gentofte University Hospital, Hellerup, Denmark, and colleagues note in the Archives of Internal Medicine.

In the current study, they assessed the risk of death and hospital admission for heart attack or heart failure associated with the use of NSAIDs in 107,092 patients who survived a first hospitalization for heart failure. Heart failure is a chronic disease in which the heart gradually loses its ability to pump blood efficiently, leaving organs starved for oxygen.

Among the study subjects, 36,354 (about 34 percent) subsequently filled at least one NSAID prescription. Overall, 60,974 patients (57 percent) died during the study, 8970 (8.4 percent) were hospitalized for heart attack, and 39,984 (37.5 percent) were hospitalized with heart failure.

Use of the NSAIDs Vioxx (rofecoxib) and Celebrex (celecoxib), as well as ibuprofen, diclofenac, and naproxen were associated with a significantly increased risk of death in study subjects.

While Vioxx was pulled from the US market due to an elevated risk of heart attacks and stroke in adults, Celebrex remains on the US market.

There was a "dose-dependent" increase in the risk of death and increased risk of hospital admission as a result of heart attack and heart failure associated with using NSAIDs, the investigators report.

"Further research is required to establish the cardiovascular risk associated with all NSAIDs in subgroups of patients with cardiovascular disease, particularly if a low dosage with analgesic effect can be used without increased risk," Gislason and colleagues note.

"In the meantime, because of the accumulating evidence," they conclude, "general awareness is required among physicians, health care authorities, and the general public about the potential cardiovascular risk of NSAIDs, in particular in patients with established cardiovascular disease or at increased cardiovascular risk."

SOURCE: Archives of Internal Medicine, January 26, 2009.