Posted on October - 12 - 2011
Taking NSAIDs Can Increase the Risk of Cardiovascular Disease
Cardiovascular disease and arthritis are both more common as people grow older. NSAIDs (nonsteroidal anti-inflammatory drugs) are the medications most often used to relieve the pain of arthritis. However, gastrointestinal ulcers and bleeding have long been recognized as a dangerous adverse effects of all NSAIDs. Let’s look at the benefits and risks of taking NSAIDs.
Prescription Drugs Removed From the Market
In the late 1990s, the Food and Drug Administration (FDA) approved several new NSAIDs, the COX-2 selective inhibitors, which had a lower incidence of peptic ulcers and intestinal bleeding. Studies quickly showed that these new drugs were associated with a greater likelihood of death from cardiovascular disease; and two of them, Vioxx (rofcoxib) and Bextra (valdecoxib), were quickly withdrawn from the market. The FDA rather reluctantly allowed the third COX-2 drug, Celebrex (celecoxib), to remain on the market.
Keep NSAID Use to a Minimum
Many subsequent studies have now linked the use of all NSAIDs except aspirin with a higher cardiovascular risk in healthy people and in those with established cardiovascular disease. In 2005, the FDA required that a Black Box warning be placed on the package insert of the NSAIDs. Guidelines have proposed that if NSAID treatment is unavoidable, the duration of its use should be as short as possible. However, a study from Denmark published recently in the journal Circulation found that individuals with a prior heart attack were at increased risk of another heart attack and death with even short-term treatment with most NSAIDs. And the higher risk was evident within the first few days of their use. The overall risk with taking the NSAIDs was increased by about 50 percent, but the risk was greatest (3-fold) with diclofenac (Voltarin) and smallest with naproxen (Aleve). A shortcoming of the study was the absence of information on the dose of NSAIDs associated with higher risk.
Safest Options for Pain Relief – What You Should Consider
Although most NSAIDs require a prescription, ibuprofen (Advil, Motrin) and naproxen can be bought over-the-counter. Unfortunately, people buying these may not get warnings from their doctors about the risks of cardiovascular disease and gastrointestinal bleeding.
The safest options for pain relief are acetaminophen and aspirin. If these are ineffective and you still choose to take other NSAIDs, you should use the lowest possible dose for the shortest time. You must also remember that the greater danger of these drugs remains gastrointestinal bleeding, particularly in older individuals and those with a prior history of intestinal disease.
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