Painkillers pose problems for people with heart disease

(Harvard Health Publications) As if people with the combination of high blood pressure and heart disease don’t already have enough to worry about, a new study suggests that common painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs) pose special problems for them.

Among participants of an international trial called INVEST, those who often used NSAIDs such as ibuprofen (Advil, Motrin and others), naproxen (Aleve, Naprosyn, and others), or celecoxib (Celebrex) were 47% more likely to have had a heart attack or stroke or to have died for any reason over three years of follow-up than those who used the drugs less, or not at all. The results were published in the July issue of the American Journal of Medicine.

Millions of people take NSAIDs to relieve pain and inflammation. They are generally safe and effective. The main worry with NSAIDs has always been upset stomach or gastrointestinal bleeding. During the last few years, researchers have raised concerns that their use may be hard on the heart as well.

This one study, and the handful that have come before it, don’t mean that people with high blood pressure and heart disease or other cardiovascular conditions should stop taking NSAIDs, especially if they are used to ease pain from a chronic condition like arthritis. But it may make sense to try an alternative first.

Talk with your doctor about taking aspirin instead of ibuprofen, naproxen, or other traditional NSAID. Aspirin eases pain and inflammation and also offers protection against myocardial infarction (heart attack) and the most common kind of stroke.

Try acetaminophen (Tylenol and many generic versions) instead of an NSAID. Be careful not to take more than 3,250 milligrams in a 24-hour period, and read medication labels—many combination over-the-counter products contain acetaminophen.

If aspirin or acetaminophen doesn’t give you enough relief, try a low-dose NSAID. Early studies suggested that naproxen it may be safer than ibuprofen, although this has been challenged.

If you take ibuprofen and aspirin, take the aspirin at least 30 minutes before the ibuprofen or eight hours afterward. Aspirin’s ability to protect the heart depends on its fitting snugly into the pocket of an enzyme known as cyclooxygenase. Ibuprofen can block aspirin’s entry into this pocket.