FDA strengthens warning that NSAIDs increase heart attack and stroke risk

In 2005, the FDA warned that taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen risk of having a heart attack or stroke increased. Last week, the unusual warning to further strengthen this initiative was made.  

This was done with the guidance of an expert group that reviewed the new information on NSAIDs and its risks. Because NSAIDs are widely used, it is important to be aware of the drawbacks of an NSAID and take measures to limit the risk. 

Many people take NSAIDs to relieve mild to moderate pain. These drugs may be particularly effective in conditions where pain is mainly due to inflammation, such as arthritis and sports injuries. Examples of commonly used over-the-counter NSAIDs include ibuprofen (Motrin, Advil) and naproxen (Aleve); Celecoxib (Celebrex), diclofenac (Cataflam, Voltaren) are prescription NSAIDs. Aspirin is also an NSAID, but not the risk of heart attack or stroke and are not covered by the new warning.

For over 15 years, experts have known that NSAIDs increase the risk of heart attack and stroke. They can also raise blood pressure and cause heart failure. The risk of heart attack and stroke gained particular notoriety with rofecoxib (Vioxx), a type of NSAID called COX-2. It caused up to 140,000 heart attacks in the United States during the five years it was on the market (Vioxx was withdrawn in 2004). The unfortunate experience with Vioxx raised awareness of cardiovascular risk of NSAIDs, and led to several studies showing that the risk is not limited to Vioxx, but is associated with all NSAIDs. 

The new FDA warnings state:

    *   Heart attack and stroke risk rose even with short-term use, and the risk may start in a few weeks to start taking an NSAID.

    *   The risk increases with high doses of NSAIDs taken for longer periods of time.
 
    *   The risk is higher for people who already have heart disease, but even those without heart disease may be at risk.

    *   Previous studies have suggested that naproxen may be safer than other types of NSDAIDs but the new review by the panel of expert evidence is not solid enough to be certain. 

NSAID use it safely
 Take NSAIDs for headache, or a few days to relieve shoulder pain is not likely to cause a heart attack or stroke. There is more that can get risky use.

Given the new warnings, the better for people with heart disease is to avoid NSAIDs if possible, and to all those who are considering taking an NSAID proceed with caution. Here are some strategies:

 *   It is important to take the lowest effective dose and to limit the length of time you take the medicine.

 *   Never take more than one type of NSAID at a time. It seems that there are risks associated with all types of NSAIDs.

 *   Try alternatives to NSAIDs such as acetaminophen. It relieves pain but does not appear to increase the risk of heart attack or stroke. However, acetaminophen can cause liver damage if the daily limit of 4,000 milligrams is exceeded, or if you drink more than three alcoholic drinks a day.

 *   If nothing works and you have to take an NSAID for arthritis or other chronic pain, try taking a "holiday" in a week from them and take acetaminophen instead.

 *   If you experience chest pain, shortness of breath or sudden difficulty speaking or weakness while taking an NSAID, see a doctor immediately.