Over-The-Counter Pain Relievers and your Heart

Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen, have long been considered the “benign” choice for pain medication among both doctors and patients. Their non-addictive nature and the perceived difficulty of overdosing contributed to their popularity. Serious side effects, like gastrointestinal ulcers and bleeding, were thought to be limited to high doses over extended periods or individuals with significant medical issues.

However, even before the opioid epidemic, there were concerns about NSAIDs. In 2004, the NSAID Vioxx was withdrawn from the market due to its association with serious cardiovascular problems such as heart attacks and strokes. Shortly afterward, a related medication, Bextra, was also discontinued due to cardiovascular risks and potentially fatal skin reactions.

While not all NSAIDs were implicated in these controversies, several studies have indicated a clear link between NSAIDs (including prescription ones like celecoxib/Celebrex and over-the-counter options like ibuprofen and naproxen) and heart attacks, strokes, and heart failure.

In 2015, the FDA strengthened its warning on all NSAIDs, stating that they could increase the risk of heart attack or stroke in patients with or without heart disease or risk factors. Numerous studies support this finding, with varying estimates of the extent to which the risk is increased, depending on the specific drugs and doses studied.

The latest on NSAIDs and risk of cardiovascular disease

In 2016, European researchers conducted a study linking nonsteroidal anti-inflammatory drugs (NSAIDs) to an increased risk of heart failure. The study involved almost seven million people with prescriptions for 27 types of NSAIDs. Results showed that those taking NSAIDs had a 20% higher risk of heart failure compared to those who were not using them, with a dose-dependent relationship: the higher the NSAID dose, the greater the risk.

A more recent Danish study examined the association between NSAID use and the risk of cardiac arrest. Analyzing data from population-level databases, the study identified over 3,300 patients who had taken NSAIDs within the month prior to death out of 29,000 cases of cardiac arrest deaths. The overall findings revealed a 31% increased risk of cardiac arrest associated with any NSAID use. Diclofenac and ibuprofen were specifically linked to a 50% and 31% increased risk, respectively. The risk was even higher for patients with known heart problems or stroke.

Professor Gunnar Gislason, one of the study authors, emphasized the study’s significance, stating that “the findings are a stark reminder that NSAIDs are not harmless” and recommended cautious use, especially in patients with cardiovascular disease or multiple cardiovascular risk factors.

So, now what?

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) remains widespread due to their effectiveness in relieving various types of pain. They are readily available, contributing to their widespread use. However, the association between NSAIDs and an increased risk of heart attack, stroke, and heart failure has raised concerns. While not everyone needs to stop using NSAIDs, awareness of these risks is crucial.

Key considerations include:

1. Patient Awareness: Patients should be informed about the potential risks associated with NSAIDs, even those without known risk factors for heart disease or stroke.

2. High-Risk Individuals: Individuals at a particularly high risk of cardiovascular events should be cautious about using these drugs, whether prescribed or over-the-counter.

3. Availability: The ease with which NSAIDs are available, often in large quantities, may contribute to misconceptions about their safety. Limiting their availability in massive quantities could help address this issue.

Ultimately, personal decisions regarding NSAID use should be made with an understanding of the potential risks and benefits. While occasional use may be acceptable for some, individuals may choose to reconsider their use in light of the associated cardiovascular risks.