Editor's note: This article has been reprinted. First published May 24, 2017.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed worldwide. In the United States, including generic NSAIDs, more than 70 million prescriptions are written and 30 billion doses are consumed each year.One
In many cases, NSAIDs are prescribed to treat back pain, headaches, menstrual cramps, and arthritis. Although most people think these drugs are harmless, conservative estimates show that more than 100,000 people are hospitalized each year due to side effects from NSAIDs, and more than 16,000 of them die.2
Side effects from long-term use of NSAIDs range from hearing loss to gastrointestinal bleeding. Unfortunately, there is no specific antidote for NSAID poisoning, which can lead to metabolic acidosis, multisystem organ failure, and death.three
Studies have shown that side effects from NSAIDs can occur even with short-term use, and if you continue to take the drugs, your risk of heart attack may increase in the first week to a month.4 The U.S. Food and Drug Administration (FDA) has been aware of the risks associated with NSAIDs since 2004.5
In reviewing all studies involving NSAIDs, the FDA recommended limiting the use of common NSAIDs. This review order was made shortly after rofecoxib (Viox) was withdrawn from the market due to increased cardiovascular risk.6 Shortly after Vioxx was discontinued, another NSAID, valdecoxib (Bextra), was pulled from shelves due to the increased risk of heart, gastrointestinal, and skin problems that outweighed the benefits of using the drug.7
What is myocardial infarction?
The heart needs a supply of oxygen and nutrients to keep the muscles pumping. There are two large coronary arteries that branch off from the aorta: the right coronary artery and the left coronary artery. These arteries branch off further to supply the heart with the oxygen and nutrients it needs.
If a larger artery or one of its branches becomes blocked, the part of the heart it nourishes becomes deprived of oxygen. If the situation continues for too long, the affected area of heart muscle will die. This is a common description of myocardial infarction (MI), literally “death of the heart muscle.”8
The signs of a heart attack are not always straightforward. There are some early signs that may not seem heart-related. Chest pain is the most common, but other symptoms may occur, and women may have a heart attack without feeling pressure in the chest.9
Although heart disease remains the number one cause of death for American women, women may develop symptoms due to less serious conditions such as acid reflux, the flu, or aging. Even if the symptoms are subtle, the consequences can be fatal.
If you or a loved one experiences these symptoms:10,11,12 Don't wait. For help, call your local emergency number (911 in the US). Early activation of the emergency system can reduce the risk of permanent heart damage and death.
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Chest pressure, described as an elephant sitting on its chest |
A feeling of fullness or pain in the center of the chest that may come and go |
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Pain in your arms, back, neck, jaw, or abdomen |
Toothache that comes and goes |
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Shortness of breath or difficulty breathing |
Cold sweat, dizziness, or nausea |
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Indigestion or feeling “choked” |
Extreme weakness or anxiety |
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fast or irregular heartbeat |
Pain spreading up to the arm |
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Unusual fatigue that may last for several days |
General malaise or a vague, uneasy feeling about illness |
NSAIDs may increase your risk of heart attack in the first week.
The aim of a 2017 study published in The BMJ was to assess the risk of MI associated with NSAID use in a real-world setting, using a statistical model (Bayesian) that translates test results into the actual probability of an event occurring.13
Researchers collected information from eight studies and more than 440,000 individuals that met the criteria, using studies that extracted information from European and Canadian health care databases.14 Researchers assessed the likelihood of an MI occurring from the first to 7 days after an individual took a specific NSAID.
They found that for celecoxib (Celebrex), ibuprofen, diclofenac (Voltaren), naproxen (Naprosyn), and rofecoxib (Vioxx), the odds of an individual experiencing an MI increased during the first seven days. This only adds to the growing body of evidence linking NSAIDs and cardiovascular symptoms.
The risk of heart attack is 24% for celecoxib (Celebrex), 48% for ibuprofen, 50% for diclofenac (Voltaren), 53% for naproxen (Aleve, Naprosyn), and 58% for rofecoxib (Vioxen). increased. The market has expanded due to increasing cardiovascular risk.15
Researchers determined that the risks associated with higher doses were higher. Over-the-counter doses are usually lower than prescription doses of NSAIDs. As evidence mounted that all NSAIDs pose cardiovascular risks, the FDA strengthened its warnings in 2015.16 This warning is based on FDA's review of the literature since the 2004 Order and includes the following information:17
- NSAIDs increased the risk of heart attack and stroke, especially at higher doses.
- NSAIDs may increase the risk of heart attack in individuals with or without a history of heart attack or risk of heart disease.
- Patients treated with NSAIDs in the first year after a heart attack were more likely to die than patients not treated with NSAIDs.
- The risk of heart failure is increased in people who use NSAIDs.
Myocardial risk differences between NSAIDs
In this video, Dr. Partha Nandi, creator and host of the medical lifestyle television show “Ask Dr. Nandi,” explains the results of another study evaluating the use of NSAIDs during upper respiratory tract infections. Results were similar to a 2017 study evaluating MI and NSAIDs in European and Canadian healthcare databases.
The researchers noted that because the study was observational, it would be impossible to draw conclusions about cause and effect from the results.18 Others have criticized the study, saying other factors may have been responsible for the increase in MI in the study.19
However, the researchers studied more than 60,000 cases of MI before concluding that current NSAID use was associated with an increased risk of acute MI.20 With NSAID use, the risk of MI began rapidly in the first week and returned to the level by day 30.
Celecoxib and diclofenac were associated with a single increased risk in the first week, while ibuprofen, naproxen, and rofecoxib were associated with an additional increased risk for 8 to 30 days after taking the drugs. Researchers speculated that differences between NSAIDs may be related to the drugs' effects on kidney function.21
The study results also suggested that the risk of MI associated with rofecoxib was greater than with other NSAIDs included in the study, consistent with previous findings that led to rofecoxib's removal from the market.
NSAIDs carry more risks
NSAIDs also increase the risk of other health conditions, some of which can be fatal. For example, researchers found that women who took NSAIDs during the first 20 weeks of pregnancy had a significantly higher risk of miscarriage.22 The study evaluated the health records of more than 50,000 Canadian women and found that women who took NSAIDs early in pregnancy had a 2.4 times higher risk of miscarriage.
Researchers hypothesize that NSAIDs' effects on hormone-like prostaglandins, which support pregnancy, may be to blame. NSAID use has also been associated with atrial fibrillation in patients with a previous MI.23 Although you may believe you can ignore this particular risk factor, studies have shown that up to 45% of heart attacks are clinically silent or have no symptoms.24
Most of these asymptomatic heart attacks are discovered during a routine physical exam or electrocardiogram (ECG), in which doctors document damage to the heart muscle.
NSAID use also increases the risk of upper and lower gastrointestinal bleeding. Upper GI bleeding is more commonly reported and occurs with all NSAID agents.25 Up to 15% of upper gastrointestinal bleeding reported in one Danish county may be due to NSAID use.
Lower GI bleeding occurs with most NSAID drugs, as does increased mucosal permeability and inflammation of the lower GI tract.26 Other findings associated with lower GI bleeding include anemia, occult blood loss, protein loss, and malabsorption.
Painkillers are bitter medicine
Use of common painkillers, including ibuprofen, has been linked to hearing loss in men27 And women.28 Prescription strength or prolonged use of NSAIDs and aspirin has been associated with interstitial nephritis.29 It is a type of kidney damage that can be permanent and lead to kidney failure.30
NSAID use may also cause other kidney dysfunction, including fluid retention, electrolyte complications, and decreased kidney function.31 It's also worth remembering that even short-term, consistent use of painkillers may increase your risk of further injury because these medications mask pain to help you continue with your activities. Additional injuries or pain may require stronger painkillers.
Pain and discomfort are common triggers for opioid prescriptions, with prescriptions increasing by more than 100% between 2000 and 2010.32 Treatment methods for injuries have improved. I believe this dramatic increase in numbers plays a significant role in the global epidemic of opioid addiction.
After just one month of morphine, there were noticeable changes in the patient's brain volume.33 The number of overdose deaths increased from just over 10,000 per year in 2002 to nearly 35,000 in 2015.34 Now some states are fighting back.35 We are trying to hold manufacturers accountable for spreading addiction through deceptive marketing.36
Pain control without drugs
Controlling your pain without addressing the underlying physical problem may increase your risk of experiencing side effects from the medications you are taking or may cause you to become dependent on stronger medications with more dangerous side effects.
It is recommended that you exhaust other options before continuing to use painkillers, even for a short period of time. The truth is that many medications used to treat pain can increase the risk of heart attack and change brain chemistry and behavior.
For example, sleep is an important factor in how we perceive pain. Getting eight hours of quality sleep each night can help overcome any discomfort you experience.37 Your experience of pain is influenced by many factors, of which sleep may be the most important. Sleep, pain, and depression are a powerfully interconnected triad where changes in one affect the other two.
If you're having trouble falling asleep or staying asleep, check out my article “33 Tips to Optimize Your Sleep Routine.” You can read more about how drugs affect the brain and 19 non-drug solutions for pain relief in our previous article, “Opioid Deaths Continue to Rise Despite Declining Prescriptions.”
