Heart Disease Health Center

NSAID Pain Relievers Raise Heart Risks

Measuring Heart Risks in NSAIDs

For the study, Swiss researchers pooled data from 31 randomized, controlled trials, which are considered the “gold standard” of scientific evidence. The trials included more than 116,000 patients.

The study also made use of innovative statistical methods that allowed researchers to compare the relative safety of different NSAID medications, even if they’d never gone head-to-head in the same clinical trial.

The medications, which are part of the NSAID class of medications, include many names familiar to American medicine cabinets, including ibuprofen, naproxen, diclofenac (Cataflam, Voltaren) and Celebrex.

In addition, researchers looked at the relative cardiovascular risks associated with three other drugs not sold in the U.S., including Vioxx, Arcoxia, and Prexige. Those drugs, structurally similar to Celebrex, are part of a special subset of the NSAID class known as Cox-2 inhibitors.

Overall, naproxen appeared to have the safest cardiovascular risk profile of the seven included in the review.

Compared to placebos, Vioxx and Prexige were associated with twice the risk of heart attack.

Ibuprofen was associated with more than three times the risk of stroke, compared to a placebo. Diclofenac was associated with almost four times the risk of cardiovascular death.

Choosing a Safer Pain Reliever

To complicate the picture, several recent studies have also suggested that opioid pain medications, which doctors have increasingly turned to as alternatives to NSAIDs in older patients at risk for stomach or kidney problems, may also have unappreciated heart risks.

A study published in the Dec. 15/27, 2010, issue of the Archives of Internal Medicine found that opioid users had an elevated risk of having a heart attack compared to users of NSAIDs. The same study found that opioid users had higher risks of fractures than those taking NSAIDs.

“It is a big problem,” Jüni says. “It just points out that we don’t have a good pharmacological alternative to treat musculoskeletal pain.”

Weighing the Risks and Benefits of Pain Medications

So what’s the safest way to treat musculoskeletal pain?

Experts say weight loss and exercise should be a person’s first line of defense against many kinds of aches and pains in joints and muscles.

If those lifestyle changes aren’t enough, however, experts suggest that patients work closely with their doctors to find the safest possible medication to get the job done.

Many think that topical treatments, like NSAID gels and patches, may relieve pain without as many adverse effects for the stomach and heart as pills. And experts say that for some patients, joint replacement surgery may be a good alternative.

If you do need NSAIDs, Jüni says it’s important to use them carefully, whether they are prescription or over-the-counter.

“If you take them, don’t take them regularly and not daily,” he says. “And if you have to take them, ideally take them once a day and not several times a day and in dosages as low as possible.”