Some anti-in­flam­ma­to­ries linked to heart dis­ease

The Hamilton Spectator - - HEALTH - MAYO CLINIC NEWS NET­WORK

Dear Mayo Clinic: Is it true that tak­ing pre­scrip­tion-strength non­s­teroidal anti-in­flam­ma­tory drugs, or NSAIDs, can in­crease my risk of heart dis­ease? How much is too much, and should I be con­cerned about reg­u­larly tak­ing over-the-counter NSAIDs?

A: Re­search has shown that tak­ing NSAIDs can raise the risk of heart dis­ease, par­tic­u­larly heart at­tacks and strokes. To keep your risk low, if you use NSAIDs, take the low­est dose pos­si­ble for the short­est amount of time nec­es­sary to re­lieve your symp­toms. NSAIDs are drugs com­monly used to treat pain and in­flam­ma­tion. Ex­am­ples in­clude the non­pre­scrip­tion med­i­ca­tions ibupro­fen (Advil and Motrin) and naproxen (Aleve). NSAIDs avail­able by pre­scrip­tion in­clude di­clofenac sodium (Voltaren and So­laraze) and cele­coxib (Cele­brex). Although Aspirin is con­sid­ered a type of NSAID, it doesn’t ap­pear to be as­so­ci­ated with a higher risk of heart attack or stroke.

The risk of heart dis­ease as­so­ci­ated with NSAIDs is high­est in peo­ple who al­ready have a heart con­di­tion. But it can be a con­cern in those who don’t have heart prob­lems, too. The rea­son for the con­nec­tion be­tween NSAIDs and heart dis­ease is un­clear. The risk was first un­cov­ered in a clin­i­cal re­search study con­ducted in 2003. The study looked at NSAIDs called COX-2 in­hibitors, and it found that the med­i­ca­tions were in­creas­ing car­dio­vas­cu­lar events. Some drugs were taken off the mar­ket as a re­sult of that study.

The COX-2 in­hibitor that’s now on the mar­ket, cele­coxib, is for­mu­lated dif­fer­ently than those in the 2003 study. The heart dis­ease risk as­so­ci­ated with cele­coxib is lower than the older COX-2 in­hibitors, but it still ex­ists. How­ever, re­search has shown that cele­coxib’s heart dis­ease risk is no higher than that of ibupro­fen or naproxen. Cele­coxib is most of­ten rec­om­mended for peo­ple with rheuma­toid arthri­tis, os­teoarthri­tis, men­strual cramps and in­jury-re­lated pain. It’s avail­able by pre­scrip­tion only.

Although there is a higher risk of heart dis­ease as­so­ci­ated with their use, that doesn’t mean these med­i­ca­tions are un­safe. If you don’t have a his­tory of heart prob­lems, it’s fine to take them oc­ca­sion­ally in the rec­om­mended doses for short-term pain re­lief.

NSAIDs be­come a more sig­nif­i­cant con­cern if you reg­u­larly use them to treat chronic con­di­tions, such as os­teoarthri­tis or rheuma­toid arthri­tis, over a long pe­riod of time. If you take mul­ti­ple doses of the med­i­ca­tions daily for weeks at a time to com­bat pain due to a chronic ill­ness, talk to your health care provider about an al­ter­na­tive that may be able to keep your symp­toms in check without in­creas­ing your heart dis­ease risk.

If you have a his­tory of heart dis­ease or other heart prob­lems, talk to your health care provider be­fore you take any these kinds of medicines, in­clud­ing those you can buy without a pre­scrip­tion. He or she may rec­om­mend you use an­other type of med­i­ca­tion, such as ac­etaminophen, for pain re­lief that isn’t as­so­ci­ated with an in­crease in heart dis­ease risk.

When­ever you visit your health care provider, make sure he or she knows about all the med­i­ca­tions you take reg­u­larly — both pre­scrip­tion and non­pre­scrip­tion, in­clud­ing anti-in­flam­ma­tory and other over-the­counter pain re­liev­ers. If you have any con­cerns about your med­i­ca­tions, your provider can help you re­view the pros and cons, and sort out what’s right for your sit­u­a­tion.

Fi­nally, when you take a non-steroidal anti-in­flam­ma­tory, read the la­bel in­struc­tions care­fully be­fore you take them, and use them only as di­rected. Talk to your health care provider if you have ques­tions.

DREAMSTIME

Re­search has shown that tak­ing some non-steroidal anti-in­flam­ma­to­ries can raise the risk of heart dis­ease.

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