NSAIDs and Heart Attack Risk


An analysis of 7,743 people suffering from osteoarthritis found that those who took NSAIDs (non-steroidal anti inflammatory drugs) were at 41 percent increased risk for suffering heart attacks, heart failure and strokes, compared to arthritis patients who did not take NSAIDs (Arthritis & Rheumatology, Atiquzzaman M, September 10, 2019). The authors say this is the first study to show that taking NSAIDs may be the main cause of the increased risk for heart attacks in people who suffer from osteoarthritis. These findings are significant because the authors corrected their data to account for other heart attack risk factors such as being poor, overweight or diabetic, or having high cholesterol, high blood pressure, or COPD (chronic obstructive pulmonary disease).

Many previous studies have shown that osteoarthritis by itself is associated with increased risk for heart attacks (Sci Rep, 2016;6:39672; Arthritis Rheumatol, 2016;68:1136–44), and that NSAIDs are associated with increased heart attack risk by 30–42 percent (BMJ, 2011;342:c7086; BMJ, 2006;332:1302–8). Another recently published study showed that taking NSAIDs is associated with increased risk for high blood pressure in people who suffer from ankylosing spondylitis (Arthritis Care Res, Sept 19, 2019). Unfortunately, there are no medications to cure osteoarthritis.

How Do NSAIDs Increase Heart Attack Risk?
NSAIDs increase risk for forming clots in your body, and heart attacks are caused by clots that block all blood flow to the part of the heart supplied by that artery.

When you damage any part of your body, such as banging or cutting yourself or pulling a muscle or tendon, you develop bleeding, swelling, redness and pain. First your body must stop the bleeding and then start the healing process. To do this, your body produces two prostaglandins:
• COX-1 to form clots to stop the bleeding, and
• COX-2 that starts the healing process for the damaged tissue.
These two necessary prostaglandins also cause pain to tell your body that you need to stop moving so you don’t increase the bleeding and extend your injury. When you have damaged tissue anywhere in your body, such as damaged cartilage in arthritis, you suffer from pain to warn you to stop moving your damaged joints intensely and extending your cartilage damage. NSAIDS block COX-1 or COX-2 or both to help relieve the pain.

Researchers tried to find pain medications that would block just COX-1 so they would not block COX-2 that promotes healing. This was a disaster because blocking COX-1 reduced clotting and increased bleeding all over the body. In 2004, researchers found that NSAIDs that blocked only COX-2 could cause heart attacks by increasing the clotting effects of COX-1 and raising blood pressure by preventing nitric oxide from widening blood vessels (Sci Transl Med, May 2, 2012;4:132ra54). Most of the pain medicines that block only COX-2 have been removed from the market because they can cause heart damage and heart failure.

In susceptible individuals, NSAIDs may be associated with salt and fluid retention, heart failure, heart attacks, high blood pressure, and heart muscle damage (Drugs, 2003;63(6):525-34). A study of 92,163 people admitted to a hospital with heart failure found that taking NSAIDs in the previous two weeks was associated with a 19 percent increased risk for hospital admission for heart failure (Brit Med J, September 2016).

My Recommendations
NSAIDs can help to relieve pain from trauma, arthritis, headaches or anything else. Most people can take them without suffering serious side effects, but NSAIDs do increase risk for heart attacks, clotting and bleeding in susceptible people. If you need medication to relieve pain, check with your doctor. Current recommendations are to take NSAIDs only when needed and at the lowest dose possible to control your pain.

Some people with chronic causes of pain, such as arthritis, get into the habit of taking NSAIDs or other pain medications daily in an effort to avoid ever feeling the pain. Instead, I recommend getting up in the morning and moving around to find out your level of pain, and to see if it gets better after you have been moving for a while. Then take the medication only if you need it.

Checked 9/21/20