People in pain do not want to hear bad news about ibuprofen or other NSAIDs. But we cannot ignore the new data. These drugs up the risk for heart attacks.
People who are hurting are caught between the proverbial rock and a hard place. Whether they’re suffering from a bad back or arthritis, there aren’t many medications that are effective. Now more bad news about ibuprofen, naproxen, celecoxib (Celebrex), meloxicam and other NSAIDs has millions worried. That’s because a new study confirms an increased risk for heart attacks.
NSAIDs and Myocardial Infarction (Heart Attack):
The evidence has been building for years that NSAIDs are bad for the cardiovascular system. Epidemiological studies have suggested that such drugs increase the risk for heart attacks, strokes, congestive heart failure and death. Here is a link to an article we wrote several years ago documenting these problems.
Popular Pain Relievers Trigger Heart Attacks!
Man grabs at his heart. He has a heart attack. risk of heart attacks, heart attack patients
Miners used to take a canary with them into the coal mine because if the bird died, the air had gone bad and it was time to get out of the mine. Heart attack patients are like those canaries. They are more vulnerable than healthy people to cardiac events, so they serve as an early …
Despite prior research many health professionals and patients were reluctant to accept the bad news about ibuprofen, celecoxib, diclofenac, meloxicam, naproxen or other NSAIDs. There have been concerns about the quality of the studies. Some experts characterized the data as “imprecise” or “inconclusive.”
Now, Canadian and European researchers have just published an important article in the BMJ (May 9, 2017). The results reaffirm the risks of NSAIDs.
What They Did:
After reviewing 82 studies for inclusion in this meta-analysis they settled on eight that met their high standards. Over 400,000 subjects were part of this analysis. There were over 61,000 heart attacks in this group. Before we translate what they found we want you to read their words for yourself:
“Through its inclusion and exclusion criteria and the definition of exposures, this meta-analysis of individual patient data (IPD) aimed to emulate the design of a large, pragmatic randomised trial comparing the main non-steroidal anti-inflammatory drugs (NSAIDs) used in the general population. By studying 61,460 myocardial infarction [heart attack] events in real world use of NSAIDs, we found that current use of a NSAID is associated with a significantly increased risk of acute myocardial infarction. This was observed for all traditional NSAIDs, including naproxen.”
Interpreting the Bad News About Ibuprofen & Other NSAIDS:
So, how bad was it? The researchers noted that “NSAIDs exhibited a rapid onset of risk for myocardial infarction in the first week of use.”
That challenges the thinking of many people who assumed that it would take months of daily use to trigger this effect. Doses of ibuprofen greater than 1200 mg per day demonstrated the risk between eight and 30 days. That is higher than the standard daily dose recommended on the label of drugs like Advil or Motrin IB. The directions for Advil Tablets read:
- “adults and children 12 years and over: take 1 tablet every 4 to 6 hours while symptoms persist
- “If pain or fever does not respond to 1 tablet, 2 tablets may be used.
- “Do not exceed 6 tablets [1200 mg] in 24 hours, unless directed by a doctor.”
If someone were to take the maximal OTC ibuprofen dose he would be approaching the “high dose” considered a risk by the researchers. Many doctors prescribe substantially higher doses for people who have suffered an injury or are complaining about chronic pain.
Bad News About Ibuprofen Not Isolated:
The authors note that NSAIDs as a class appear to have negative cardiovascular consequences. (The exception is aspirin, which may reduce the risk for heart attacks.) The higher the dose the greater the danger.
The Risk in Relative Terms:
Here is what was uncovered in terms of relative risk for people who took different NSAIDs for a week or less:
- Ibuprofen: a 48% increased risk of heart attack
- Diclofenac (Voltaren): a 50% increased risk of heart attack
- Naproxen (Aleve, diclofenac): a 53% increased risk of heart attack
- Celecoxib (Celebrex): 24%
Absolute Risk vs. Relative Risk:
In fairness, it is important to note that relative risk is almost always a scary number. A 50% increase in the risk of heart attack seems huge. And yet the absolute risk of suffering a heart attack is actually quite small. That’s because relatively few people will experience a heart attack in the first place.