Heart risk similar for all NSAIDs other than aspirin

Heart risk similar for all NSAIDs other than aspirin

The Medicine Cabinet: Ask the Harvard Experts

By Howard LeWine, M.D.

Q: I take ibuprofen almost every day for arthritis pain. I keep reading about warnings regarding a higher risk of heart problems in people that take these kinds of anti-inflammatory drugs. Should I be taking a different one?

A: Despite new research, the answer is unclear.

Like you, millions of people with aching joints and muscles rely on drugs known as non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to ease the pain. These popular medications also relieve headaches, cool fevers, and dampen inflammation.

But with the exception of aspirin, most NSAIDs pose cardiovascular risks. Taking an NSAID daily can increase blood pressure and raise the risk of heart attack and stroke. While the danger is greatest in people with heart disease, it’s also present in people without any signs of the disease.

Researchers have been investigating the safety of NSAIDs for more than a decade. Another large study was recently published to again look at your question. It was a 10-year-long investigation of more than 24,000 people with arthritis that were assigned to take ibuprofen, naproxen or celecoxib. Ibuprofen and naproxen can be purchased over-the-counter. Celecoxib needs a prescription.

The study results suggested that the cardiovascular risks for all three were similar. However, celecoxib did have some other advantages. It was less likely to cause serious internal bleeding compared with to the study participants taking ibuprofen or naproxen.

But limitations of the study created some uncertainty about the findings. That’s because 69 percent of the participants had stopped taking their assigned drug by the end of the study. Also the average doses of the drugs were not comparable. The dose of celecoxib was lower than the dose needed to provide the same pain relief as ibuprofen and naproxen provided.

So it’s still not entirely clear whether any of these three NSAIDs is safer for your heart than the others. If you’re at risk for heart disease (or already have it), an NSAID for a headache or other occasional aches and pains is relatively safe.

But if you need an NSAID several times a week, or every day, start with a low dose. Increase the dose a bit if it’s not helping enough. And take it for the shortest possible time.

By the way, if you take ibuprofen and aspirin, take the aspirin at least 30 minutes before the ibuprofen or eight hours afterward. Ibuprofen can temporarily block aspirin’s beneficial anti-clotting action.

(Howard LeWine, M.D. is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)

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