NSAIDs and Heart Disease: What You Should Know

Nearly 10 years ago the FDA strengthened its warning about the increased risk of heart attack and stroke associated with non-steroidal anti-inflammatory drugs (NSAIDs). With millions of people using these drugs regularly, it’s crucial to understand the risks and how to protect yourself. Here’s what you need to know:

What Are NSAIDs?

NSAIDs are medications commonly used to treat pain and inflammation. Over-the-counter brands include Advil and Motrin (ibuprofen) and Aleve (naproxen). Prescription NSAIDs include drugs like Celebrex (celecoxib), Disalcid (salsalate), Indocin (indomethacin), Toradol (ketorolac), and Voltaren (diclofenac). Most people have used one of these medications at some point in their lives.

What NSAIDs Are Not

Tylenol (acetaminophen) is not a NSAID and was not affected by this warning. Though aspirin has anti-inflammatory properties, it was also not included in the FDA’s warning about NSAID use.

Who Is at Risk?

Anyone using NSAIDs is at higher risk of developing a heart attack or stroke. Those with known heart disease, a history of heart attack or stroke, and individuals with risk factors for heart disease—such as smoking, diabetes, high blood pressure, and high cholesterol—are especially vulnerable. The risk increases with higher doses and prolonged use, but even short-term, low-dose use can be harmful.

Why do NSAIDS Increase Heart Attack and Stroke Risk

NSAIDs can increase the propensity of blood to clot, and blood clot formation in arteries is the main mechanism underlying heart attack and stroke occurrence.  NSAIDs can also cause sodium retention directly and/or through impairing kidney function, leading to higher blood pressure readings, exacerbation of heart failure symptoms, and increasing risk of developing atrial fibrillation.

How to Minimize Your Risk

The best way to lower your risk is to use NSAIDs sparingly. For mild pain, consider alternatives like Tylenol or aspirin. If you need to use NSAIDs, stick to the lowest effective dose for the shortest amount of time. Additionally, addressing any heart disease risk factors—such as high cholesterol or blood pressure—can help make you a lower-risk NSAID user.

When to Seek Medical Attention

Be vigilant about new symptoms such as chest pain, shortness of breath, weakness, or problems with speech or vision. If you experience any of these, seek medical attention immediately - whether or not you are using NSAIDs.

Putting It in Perspective

NSAIDs have been widely used for decades,  and many people take these drugs without issues, but the strengthened FDA warning is a reminder that all medications carry risks, with risk often increasing with higher medication doses. Whenever possible, we should all aim to minimize our use of medications, including NSAIDs, by addressing the root cause of our symptoms and opting for safer alternatives whenever possible and medically advisable.