NSAIDs may increase your risk for heart disease, new research suggests

Heart Health

by Scott Ewing, DO

Jun 13, 2017

Do you take non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief or fever management? New research supports the claim that people who routinely take NSAIDs could face a higher risk of having a heart attack.

The recent study, published in the British Medical Journal, found that all commonly used NSAIDs — including over-the-counter ibuprofen and naproxen and prescription diclofenac and celecoxib, were associated with this increased risk of heart attack.

Collectively, 446,763 people were studied with 61,460 suffering a heart attack.

The results showed that increased risk of heart attack was greatest with higher doses of NSAIDs. High daily doses include:

  • Ibuprofen (Advil, Motrin) >1200 mg
  • Naproxen (Midol, Aleve) > 750 mg
  • Celecoxib (Celebrex) > 200 mg
  • Diclofenac (Voltaren) > 100 mg

Overall, the study showed a 20 to 50 percent increase in the risk of heart attack when using NSAIDs compared with not using these medications.

This increased risk sounds scary, but it is important to point out that for most of us, our absolute risk is very small to begin with and remains very small even with the addition of 20 to 50 percent.

As a result of this increase, the risk of heart attack due to NSAIDs is on average about 1 percent annually.

When Is It OK to Take NSAIDs?

First, look at your risk factors. Risk factors include age, high blood pressure, diabetes, known coronary artery disease, prior heart attack, prior stroke and underlying kidney disease.

With few risk factors, the occasional use of NSAIDs for pain or fever management is very reasonable. There is little addition to your underlying low risk of heart attack.

If you have several risk factors, then you should consider looking for alternatives to NSAIDs for pain relief. Over-the-counter acetaminophen is an excellent option for pain or fever management.

If additional pain management is needed, then prescription narcotic and non-narcotic alternatives may be needed. Please talk to your primary care doctor.

Where Does Aspirin Fit Into All of This?

While aspirin can be an effective NSAID for pain and fever management, unfortunately, there is an associated risk of peptic ulcer disease and gastrointestinal bleeding, and I would not recommend the routine use of aspirin for pain and fever management.

Of course, many of us take a single aspirin (81 mg or 325 mg) daily to prevent heart attack and stroke. This should be continued and no changes should be made until one talks to their physician.

The Bottom Line

For someone who is young and healthy and takes a NSAID for lower back pain, the risk of heart attack is already very low and NSAID use does little to change this.

On the other hand, for an 80-year-old who has diabetes, high blood pressure, coronary artery disease and previous bypass surgery, the risk could be more substantial and alternatives to NSAID use should be explored.

Overall, one should always take caution when considering painkillers and should consult with their physician about potential risk factors.

About the Author

Dr. Scott Ewing, DO, is an interventional cardiologist on the medical staff at Baylor Scott & White Heart and Vascular Hospital – Fort Worth.

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