Does taking nonsteroidal anti-inflammatory drugs (NSAIDs) increase my risk of heart attack or stroke?
Answers from Stephen Kopecky, M.D.
Yes. Nonsteroidal anti-inflammatory drugs (NSAIDs) — medications commonly used to treat pain and inflammation — may increase the risk of a heart attack or stroke.
Examples of NSAIDs include ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, others), and prescription NSAIDs such as diclofenac sodium (Voltaren, Solaraze, others) and celecoxib (Celebrex). More research is needed to determine whether some NSAIDs are more or less likely to increase these risks than others.
Although aspirin is a type of NSAID, it doesn't appear to be associated with a higher risk of heart attack or stroke.
If you take NSAIDs and have cardiovascular disease or you're at high risk of it, you may have a higher risk of having a heart attack or stroke than is someone who takes NSAIDs but doesn't have cardiovascular disease. But even people without cardiovascular disease who take NSAIDs may be at increased risk of heart attack or stroke.
To help ease muscle or joint pain, consider trying other therapies — such as hot or cold packs, or physical therapy — before taking NSAIDs. Your doctor may suggest other medications as alternatives to NSAIDs. For example, your doctor may recommend that you take acetaminophen (Tylenol, others) for general pain relief, which doesn't increase the risk of heart attacks.
If you need to take an NSAID, take the lowest dose possible for the shortest time needed. But be aware that serious side effects can occur as early as the first weeks of using an NSAID, and the risk may increase the longer you are taking an NSAID. Taking NSAIDs at higher doses also may increase your risk of a heart attack or stroke.
If you need to take NSAIDs for a long time, or if you have cardiovascular disease, talk to your doctor. Your doctor may discuss which NSAIDs may be appropriate for you and whether other medications may be recommended for you.
If you take aspirin to help prevent a heart attack, talk with your doctor before taking NSAIDs. Some NSAIDs may interact with aspirin and affect its ability to help prevent a heart attack.
If you're taking an NSAID and you notice any signs or symptoms of a heart attack or stroke — such as chest pain, shortness of breath, weakness in one part of the body or side of the body, or sudden slurred speech — get medical attention right away.
Many people can generally take NSAIDs to treat pain, fever and inflammation. But keep in mind that there may be an increased risk of a heart attack or stroke. Also, read the label instructions carefully before taking NSAIDs, and use NSAIDs as directed. Talk to your doctor if you have questions about NSAIDs.
Aug. 14, 2015
Stephen Kopecky, M.D.
See more Expert Answers
- FDA Drug Safety Communication: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes. U.S Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/ucm451800.htm. Accessed July 14, 2015.
- Antman EM, et al. Use of nonsteroidal antiinflammatory drugs: An update for clinicians: A scientific statement from the American Heart Association. Circulation. 2007;115:1634.
- Schjerning Olson AM, et al. Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction in patients with prior myocardial infarction: A nationwide cohort study. Circulation. 2011;123:2226.
- Solomon DH. Nonselective NSAIDs: Adverse cardiovascular effects. http://www.uptodate.com/home. Accessed July 10, 2015.
- Coxib and traditional NSAID Trialists' (CNT) Collaboration. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: Meta-analyses of individual participant data from randomised trials. The Lancet. 2013;382:769.
- Brune K, et al. New insights into the use of currently available non-steroidal anti-inflammatory drugs. Journal of Pain Research. 2015;8:105.
- FDA strengthens warning of heart attack and stroke risk for non-steroidal anti-inflammatory drugs. U.S Food and Drug Administration. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm453610.htm. Accessed July 15, 2015.
- Osteoarthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Osteoarthritis/. Accessed July 16, 2015.
- Kopecky SL (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 5, 2015.