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Do you have a hidden heart risk in your medicine cabinet?

The Bottom Line

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain relief, including headaches, cramps and general pain.
  • Side effects can include gastrointestinal symptoms like stomach pain, vomiting, and diarrhea.
  • Research shows that celecoxib, diclofenac, ibuprofen, naproxen, and rofecoxib can increase your risk of heart attack; higher doses are associated with a higher risk, and your risk returns to normal after you stop taking the NSAID.
  • Although aspirin is an NSAID, it is protective and can reduce heart attacks when taken in low-doses.

Millions of people have nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil, Aleve, Anaprox, Celebrex, Motrin and Voltaren (1;2), sitting in their bathroom cabinet, and many people will pop one or two casually at the slightest pain. NSAIDs, are available as pills, creams or gels, and many can be purchased over-the-counter (1). So, they are safe, right?


NSAIDs can be used to tackle inflammation and all sorts of aches and pains – headaches, sore muscles, achy joints, cramps and toothaches – to name a few (1). Possible side effects from NSAIDs include stomach pain, constipation, vomiting, diarrhea and dizziness. NSAIDs can also have more serious effects on the heart. Your risk for these side effects is higher if you are taking other medications, have certain health conditions, or have been taking NSAIDs for a long time (2). Studies have also linked NSAIDs to an increased risk of heart attack (3;4), with the level of risk tied to the type of NSAID, how much is taken, and for how long (3;4).


Aspirin is also an NSAID (1), and can produce side effects such as stomach and intestinal ulcers, and internal bleeding (2). In addition to being used to treat pain, fever, and inflammation, it is also used in low doses to treat or prevent heart attacks and stroke (1). Unlike other NSAIDs, evidence shows that taking aspirin in low doses can reduce non-fatal heart attacks (5).


But what about those other NSAIDs? Should you avoid taking them for aches and pains?


What the research tells us

A recently published review assessed the risk of heart attack with the use of the following NSAIDs: celecoxib, diclofenac, ibuprofen, naproxen, and rofecoxib (which is no longer available). There is now convincing evidence that these oral NSAIDs (the pill form) – can increase your risk of heart attack, including naproxen (4), which was previously thought to be a safer option (3). Given its protective effect on preventing heart attacks, aspirin was not included in the review.


The evidence also shows that you can be at increased risk of heart attack as soon as you begin taking an NSAID, and that the higher the dose, the higher your risk. In most cases, longer NSAID use (for more than 30 days) does not appear to increase your risk of heart attack beyond the risk seen with short term usage. Once you stop taking NSAIDS, your risk of heart attack returns to normal over time (4).


Should you chuck the NSAIDs sitting in your bathroom cabinet over these findings? Not necessarily. NSAIDs are still a valuable tool for millions of people. But don’t take their safety for granted either. If you do need an NSAID for pain, make sure that you are aware of its risks. Also, work closely with your doctor to find the safest possible medication, dose, and duration to get the job done. If you are taking aspirin to prevent a heart attack, make sure you discuss with your doctor what to take for aches and pains before reaching for another NSAID.


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Author Details

References

  1. Soloman DH. Patient education: Nonsteroidal anti-inflammatory drugs (NSAIDs) (Beyond the basics). [Internet] 2017. [cited December 2017]. Available from https://www.uptodate.com/contents/nonsteroidal-antiinflammatory-drugs-nsaids-beyond-the-basics
  2. Food and Drug Administration. Medication guide for non-steroidal anti-inflammatory drugs (NSAIDs). [Internet] 2007. Available from https://www.fda.gov/downloads/Drugs/DrugSafety/ucm089162.pdf
  3. Bhala N, Emberson J, Merhi A, et al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: Meta-analyses of individual participant data from randomised trials. Lancet. 2013; 382(9894):769-779. doi: 10.1016/S0140-6736(13)60900-9. 
  4. Bally M, Dendukuri N, Rich B, et al. Risk of acute myocardial infarction with NSAIDs in real world use: Bayesian meta-analysis of individual patient data. BMJ. 2017; 357:j1909. doi: 10.1136/bmj.j1909. 
  5. Guirguis-Blake MJ, Evans CV, Senger, CA, et al. Aspirin for the primary prevention of cardiovascular events: A systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2016; 164(12):804-813. 

 

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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