Which NSAID Is Safest for Your Heart?

Some painkillers are less likely than others to raise your cardiovascular disease risk.

Many studies have shown that people should take precautions when using nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain, fever and inflammation because of the drugs' well-known cardiovascular risks. So, how do you choose the NSAID, if any, that's safest for you?

To help answer that question, a group of scientists looked at how various NSAIDs stacked up against each other when it came to heart safety, a comparison that's never been studied in such depth. They published their findings in the journal PLoS Medicine from the Public Library of Science.

About the study

The researchers pooled data from 51 observational studies of more than 2.7 million people at both high and low risk for cardiovascular disease. By analyzing a large number of observational studies, researchers could gather data about individual drugs and their risks when used in settings other than those in controlled clinical trials. The downside of observational studies is that a true cause and effect can't be established between an action (such as taking NSAIDs) and a condition (such as a heart attack) since other factors can influence results.

The study also took into consideration the varying lengths of time people took NSAIDs in home settings, instead of in structured clinical trials.

Rating the NSAIDs

Unlike similar NSAID analyses, this latest meta-analysis included people taking low and over-the-counter doses of NSAIDs. Most other meta-analyses have studied results that usually involve higher prescription doses. Prescription and nonprescription naproxen was deemed the least likely NSAID to raise cardiovascular risk, with over-the-counter ibuprofen a close second.

The two NSAIDs with the highest risks are either no longer on the market (rofecoxib [Vioxx]) or not available in the United States (diclofenac).

Among low-risk people who take NSAIDs, the chance of a heart attack or other adverse cardiovascular event is small, and an occasional NSAID should cause no harm. But NSAIDs significantly increase the risk of such an event in people with underlying heart disease and should be avoided when possible.

NSAID precautions

If you take NSAIDs for a prolonged period, talk with your doctor about your risks. Over time, large doses of NSAIDs can do damage to the kidney, a condition called nephrotoxicity. You may also be susceptible to the gastric distress that NSAIDs can cause.

On average, people who take NSAIDs are four times more likely to develop gastrointestinal (GI) complications, such as GI bleeding and ulcers. Always take the lowest effective dose, and never exceed the maximum recommended dose unless instructed by your doctor.

Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50

Publication Review By: the Editorial Staff at Healthcommunities.com

Published: 09 Jul 2013

Last Modified: 18 Sep 2015