Risk of heart disease associated with NSAIDs

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 NSAID use, that doesn’t mean these medications are unsafe. If you don’t have a history of heart problems, it’s fine to take NSAIDs 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 NSAIDs 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 NSAIDs, 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 NSAIDs and other over-the-counter 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 NSAIDs, read the label instructions carefully before you take them, and use NSAIDs only as directed. Talk to your health care provider if you have questions about NSAIDs.