FDA Strengthens Warning that NSAIDs, like Ibuprofen and Naproxen, Can Cause Heart Attacks and Strokes

We have heard for a number of years that COX2 inhibitors like Vioxx and Celebrex create an increased risk for heart attack or stroke and this is why Vioxx was taken off the market in 2004.  However, now it has become apparent from the recent research that all NSAIDs, including very commonly used drugs, like ibuprofen (Advil) and naproxen (Alleve), increase the risk for heart attack and stroke.  This has led the FDA to strengthen and update existing labels warning that all non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) increase the chance of a heart attack or stroke.

These findings for NSAIDs should not be that surprising, since we have known for a long time that they tend to raise blood pressure, which is a known risk factor for heart attacks and strokes.  The FDA committee found that the risk of heart attack or stroke occurs within the first few weeks of taking the NSAID. (1)  Both longer term usage and higher dosages increase the risk even more.  This increased risk of heart attack or stroke is even for those individuals who had not previous risk, ie. otherwise healthy people.  In fact, one study in the European Heart Journal found a 40% increased risk of an initial heart attack in those who had used NSAIDs.(2)

 Another shocking finding was that patients who were treated with NSAIDs following a heart attack were more likely to die in the first year after the heart attack than those who were not treated with NSAIDs.  This is disturbing, since it is common medical advice to recommend taking low dose aspirin (an NSAID) after a heart attack to prevent another one.  Is this really good advise?   And patients who have preexisting heart disease or risk factors are more likely to suffer a heart or stroke following NSAID use.   There is also an increased risk of heart failure with NSAID use.

We have now learned that one of the classification of drugs that is believed to be among the safest–NSAIDs, significantly increases your risk of heart attack and stroke.  And this is on top of the long understood risks of damage to the gastrointestinal tract (such as bleeding ulcers and upsetting the microbiome that is so important for our health) and kidney damage that can occur from taking NSAIDs.   So how then should we manage pain?   If the pain is musculoskeletal in origin, chiropractic care and acupuncture are ways to treat the underlying imbalances of many cases of back or neck or other joint pain, thus correcting the condition.  When pain is sytemic, the functional medicine (nutritional) approach that Dr. Weitz and other practitioners take may help patients identify food sensitivities or other underlying causes of inflammation, rather than just taking high dosages of pain relievers.  Correction results from dietary changes.

When short term pain relief is needed, natural substances may help to alleviate inflammation, as might an overall anti-inflammatory diet. Anti-inflammatory herbs and spices include hops, ginger, turmeric and rosemary, proteolytic enzymes, and a diet low in omega-6-rich vegetable and seed oils, and higher in plant and animal sourced omega-3s may also help correct the imbalance of pro- and anti-inflammatory prostaglandins.  Speak to Dr. Weitz or Amber about this.

2. Helin-Salmivaara A, Virtanen A, Vesalainen R, et al. NSAID use is associated with hospitalizations for first myocardial infarction in the general population: a nationwide case-control study from Finland.
Eur Heart J 2006;27:1657-1663.


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