Can taking NSAIDs for arthritis increase risk for heart disease?

Many people take medications for both heart disease and arthritis. Typically, nonsteroidal anti-inflammatory drugs (NSAIDs) are used to relieve the pain and inflammation of arthritis. This class of medications includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn) and celecoxib (Celebrex). Celebrex carries a warning because it has been linked to an increased risk of having a heart attack or stroke.

Emerging research suggests that most NSAIDs, not just Celebrex, increase risk for heart attacks and strokes. Ibuprofen and diclofenac (Cataflam, Voltaren), for example, also appear to increase the risk of cardiovascular disease. An exception is low-dose aspirin, which helps prevent blood clots but may also increase risk for gastrointestinal bleeding. Naproxen does not appear to increase cardiovascular risk, but it also does not protect against heart attacks, as it was once thought to do. When taken routinely, NSAIDs also increase the risk of developing high blood pressure.

It is still possible to treat your arthritis pain even if you have heart disease. But a few common-sense precautions—and perspective—may help. The following strategy should help most people:

  1. Start with aspirin or acetaminophen (Tylenol).
  2. Ibuprofen or another NSAID should be tried next. Just remember to mention this to your doctor, so your blood pressure can be monitored. If taking these drugs in the past caused gastrointestinal bleeding or gave you an ulcer, ask your doctor for advice. Sometimes taking an NSAID with a meal, or taking another medication to protect your stomach, such as omeprazole (Prilosec), which is available over-the-counter, can quell gastric distress.
  3. The COX-2 inhibitor Celebrex should be used as a last resort because it can increase the risk of having a heart attack.
  4. If you take any NSAID, try to do so at the lowest dose possible and only as needed.
Dr. Juan P. Villablanca, MD

Taking nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis could increase the risk for heart disease in people with a history of cardiovascular disease. If you have had a heart attack or heart bypass surgery, or if you have high cholesterol or high triglycerides in your blood, your doctor will want to carefully supervise you if you take NSAIDs. NSAIDs decrease the inflammation around arthritic sites and can be very effective at decreasing pain. If you do not have any cardiovascular risk factors, your doctor may suggest that you take NSAIDs and will check from time to time to make sure you are not having any problems. Some people can develop stomach irritations, so your doctor may give you a list of symptoms to be aware of.

NSAIDs such as aspirin, ibuprofen, ketoprofen and naproxen help diminish pain, swelling and inflammation. However, each NSAID is a different chemical and can have different effects in the body.

NSAIDs may cause side effects including ringing in your ears, bruising, heart problems, gastric ulcers, stomach irritation, and liver and kidney damage. The longer you use NSAIDs, the more likely you are to have side effects and the more serious those effects can be. Many other drugs cannot be taken with NSAIDs—in particular, the blood thinner warfarin (Coumadin). NSAIDS should be used with caution in people over 65 and in those with any history of ulcers or gastrointestinal bleeding, congestive heart failure, renal insufficiency and hypertension. Even the nonprescription, over-the-counter forms of these medications have the same risks. It's important to ask your healthcare professional for safety information associated with pain relievers with your personal health history in mind.

A newer NSAID (called a COX-2 specific inhibitor) inhibits an enzyme (COX-2), which triggers pain and inflammation, while sparing an enzyme called COX-1, which helps maintain the normal stomach lining. The COX-2 inhibitor celecoxib (Celebrex) is sometimes prescribed for rheumatoid arthritis, osteoarthritis, and other pain-causing conditions, such as acute pain and menstrual cramps. Celebrex is currently the only COX-2 inhibitor on the market. Celebrex may increase the risk of heart attack and stroke; discuss these risks with your healthcare professional. And if you are currently taking Celebrex and think you are having an allergic reaction or have other severe or unusual symptoms while taking any NSAID, call your healthcare professional immediately.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.