Is Ibuprofen Bad for My Heart? What You Need to Know About NSAIDs

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Update July 2015: The FDA is strengthening the existing black box warning on all prescription and over-the-counter NSAIDs. The current warning has been in place since 2005, but based on a recent review, the labeling will be updated with new information and stronger language. You should know that there is greater risk at higher doses, and there may be an increased risk of heart attack or stroke as early as the first weeks of use. For the full announcement from the FDA, go here.

Ibuprofen, Voltaren, Motrin, Advil, naproxen, and Aleve are all different types of the same bird: NSAIDS. NSAIDS are non-steroidal anti-inflammatory drugs that will come to your rescue for a headache, fever, swelling in the knee, pain after surgery and a tooth ache—just to scratch the surface. They are of great help in the short-term, but pay attention to what we know about NSAIDS and the heart. Strangely, naproxen comes out looking like a rose here so this may be your go-to med.

The risks of major cardiovascular events, such as myocardial infarction (MI), stroke, and death, appear to be increased to a similar degree by use of most NSAIDs at high dose, with the exception of naproxen, which does not increase such risk.

How risky are they?

We get our numbers here from years of rigorous studies done asking this question: are you at increased risk of stroke and heart attack if you take NSAIDS?

  •  There was an increase in major coronary heart disease events in people taking high dose diclofenac (Voltaren), high dose ibuprofen and the COX-2 inhibitors (Celebrex, meloxicam)

  •  For patients at low cardiovascular risk using diclofenac, ibuprofen, or a COX-2 inhibitor, the estimated increase was two events per 1000 persons per year, while there was no increased risk of such an event with use of naproxen.

Can I use them if I already have cardiovascular disease?

NSAIDs increase the risk of new cardiovascular events in patients with established heart disease, so you should use an alternative med (Tylenol) or short term naproxen instead. If you do take an NSAID use it at the lowest dose for the shortest period of time possible. Do not take NSAIDs if you’ve had a recent heart attack or heart surgery for example.

  •  In patients at high cardiovascular risk, the increased number of major vascular events for patients taking diclofenac or ibuprofen was estimated at seven to eight events per 1000 persons per year.

  •  COX-2 inhibitors (Celebrex and meloxicam), diclofenac, and ibuprofen increased the absolute annual excess risk of a major vascular event to a similar degree in these patients.

  •  Again, naproxen did not increase such risk.

Naproxen . . . just sayin’.

Dr O.

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