Can NSAIDs increase my risk of heart attack or stroke?


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NSAIDS like ibuprofen help manage pain and inflammation. But are they safe for the heart?
When you have a headache, what do you do? If you typically grab the nearest bottle of ibuprofen, you’re not alone. Millions of Americans take nonsteroidal anti-inflammatory drugs (NSAIDs) every day. These common prescription and over-the-counter pain relievers – Motrin, Advil, Aleve, and Celebrex, for instance – are used for everything from flu symptoms, menstrual cramps, and muscle strains to arthritis, back pain, and other chronic conditions.

Use of these painkillers is widespread and generally safe. Yet, many people don’t pay attention to the recommended dosage or potential side effects. In fact, a 2005 study showed that 26 percent of survey respondents used more than the recommended dose on an NSAID label, and 60 percent were unaware of potential NSAID side effects, which include heart problems.

In July 2015, the Food and Drug Administration (FDA) strengthened its warning of increased heart attack and stroke risk associated with prescription non-aspirin NSAIDs. The department is requiring that prescription labels be updated and has requested that over-the-counter NSAID labels be updated as well.

Before you throw away all of your pain relievers, talk to your doctor about the drugs’ potential risks and benefits.

What are the heart risks of NSAIDs?

Heart concerns over NSAID use took off in the early 2000s. Studies showed an increased risk of heart problems in patients who took a class of NSAIDs that included Celebrex and Vioxx. More recently, we’ve discovered nearly all NSAIDs pose some risk to cardiovascular health – especially in those who use them heavily.

Many people take aspirin to help prevent heart attacks and strokes. What makes aspirin different from other NSAIDs? While aspirin prevents blood platelets from clumping together to form dangerous clots in blood vessels, non-aspirin NSAIDs can increase blood clot formation, which can lead to heart attacks and strokes.

Based on these studies, the FDA now requires prescription non-aspirin NSAID labels to state:

  • The risk of heart attack or stroke starts as early as the first week of NSAID use and increases with prolonged use.
  • Heart risk is greater at higher doses.
  • While all patients are at risk despite their health history, those with heart disease or risk factors are at higher risk.
Despite the increased attention to these potential cardiovascular problems, the risk is still small. It’s important to examine NSAID use on a case-by-case basis.

Should I keep taking NSAIDs?

When we prescribe a medication, we weigh the risks and benefits to the patient. If you have high blood pressure, an NSAID may make you retain fluid or affect your blood pressure control, in which case it might not be worth taking it to ease a minor ache or pain.

However, if you have severe arthritis in your knee and can’t get up to walk without medication, a small increased risk to your heart may be acceptable. Mobility and living free of pain play a big part in quality of life, so we want to preserve that. I’m often OK with my patients taking NSAIDs if they don’t have kidney problems or are otherwise in good health.

When using an NSAID, keep these tips in mind:

  • Check the labels to buy the lowest dose necessary, and don’t go over the recommended dosage.
  • Use the medication for the least amount of time needed.
  • Talk with your physician if you are taking an NSAID for a prolonged period or if you have heart problems or are at increased risk for them.

What are the alternatives to NSAIDs?

In cases where the risk of taking an NSAID outweighs the benefits, there are alternatives we can try to manage your pain, including:

  • Non-narcotic non-steroidal pain medications, such as acetaminophen or tramadol
  • Topical medications rubbed into the skin to relieve muscle or joint pain (while some of these are NSAIDs, they’re absorbed differently and may be safer than the pill form)
  • Exercise or physical therapy
  • Cognitive behavioral therapy
If you have a history of cardiac problems or increased risk factors, talk to you doctor before taking an NSAID. While it’s important to understand the risks that NSAIDs pose, there’s no reason to panic the next time you need relief from a bad headache.

If you are concerned about NSAIDs and your heart health, request an appointment online or call 214-645-8300.