Korin Miller in SELF wrote that you probably heard recently that new research has linked non-steroidal anti-inflammatory drugs (NSAIDs) with an increased risk of a heart attack. Common over-the-counter NSAIDs include ibuprofen (Motrin, Advil) and naproxen (Aleve), and people promptly freaked out over the news. But before you do the same, know this: This isn’t as bad as it sounds.
First, some basics on the research. The meta-analysis, which was published in the BMJ, studied data from 446,763 people, including more than 61,000 who had heart attacks. Researchers looked at study participants’ heart health and how often they took NSAIDs, and determined that taking any dose of NSAIDs for a week, month, or more than a month was associated with an increased risk of having a heart attack. Risks ranged from 20 to 50 percent compared to people who didn’t take NSAIDs, and the risk level increased as quickly as one week into the use of any NSAID.
But here’s a very important point: The study was observational and not causational, meaning this doesn’t definitively say ibuprofen causes heart attacks.
Instead, it means the scientists simply observed that people who took NSAIDs had a higher risk of heart attacks. They found an association, not causation-based proof that NSAIDs are bad news for your heart.
Experts say you shouldn’t chuck the ibuprofen sitting in your bathroom cabinet over this. “People take these drugs because they’re sick, and we know that when people have health issues, they’re more likely to have cardiac problems arise,” Richard Wright, M.D., a cardiologist at Providence Saint John’s Health Center in Santa Monica, California, tells SELF. “It’s the same thing as the idea that if someone goes to the emergency room, they’re more likely to die. It’s not because the ER is killing them—they go to the ER because they’re sick.”
This issue is a lot more complicated than simply pitting the heart attack risk for people who regularly take NSAIDs versus that of the general population. In fact, it’s hard to even pinpoint an exact number for the general population’s risk of heart attacks, since it’s based on factors like age and lifestyle, which vary wildly between people.
With that said, a good estimate for American adults’ heart attack risk is about five in 1,000 for year, Wright says. “Even if NSAIDs raise that risk by 50 percent, which is dubious at best, the absolute increase in risk for those taking such drugs is perhaps two or three per thousand people per year,” he said. “Most of my patients will gladly accept this slight risk, if taking these drugs relieve their aches and pains and allow them to function.”
Also worth noting: This association between NSAIDs and heart health isn’t new at all.
Medhat Mikhael, M.D., a pain management specialist and medical director of the non-operative program at the Center for Spine Health at Orange Coast Memorial Medical Center in Fountain Valley, California, tells SELF that the news isn’t surprising to members of the medical community. He points out that in 2005, the Food and Drug Adminstration (FDA) warned that taking NSAIDs increased a person’s risk of having a heart attack or stroke. The FDA particularly flagged rofecoxib, a type of NSAID called a COX-2 inhibitor (it was removed from shelves in 2004), but noted that additional research found a link between all NSAIDs and heart attack risk.
The FDA also noted in a 2015 follow-up warning that the risk is greatest for people who already have heart disease, although those who don’t have heart disease may also be at risk. “Those serious side effects can occur as early as the first few weeks of using an NSAID, and the risk might rise the longer people take NSAIDs,” the FDA said in its warning.
The risk is nowhere near large enough for doctors to avoid recommending NSAIDs for most patients.
“If a normal young person threw out their back and their doctor prescribed NSAIDs for two weeks, am I concerned that this is going to cause a heart attack? Absolutely not,” Mikhael says. However, he stresses that doctors don’t recommend taking NSAIDs for long periods of time anyway. “You can use it one day when you have a flare-up, but I don’t want you to be on it for a long time on a daily basis,” he says. “Long-term use can have side effects.”
Those include the potential for a gastric ulcer and kidney disease, he says—both more likely reasons he would recommend against long-term NSAID use than potential heart issues, he notes.
Some people are interpreting the findings as a reason to switch to acetaminophen (aka Tylenol), but Mikhael says that’s not necessarily the right move. While it may not carry the same risks, it’s not completely risk-free, he says, noting that long-term use of acetaminophen can also have a toxic effect on a person’s liver.
There are obvious benefits to taking NSAIDs, like the fact that they can help with pain relief. It’s just about using good judgment as to whether it’s the right choice for you.
If you have any underlying heart conditions, you should absolutely talk to your doctor before taking any sort of pain reliever or other medicine, just to be safe. Otherwise? “If you have a need to take NSAIDs, take them,” Wright says. “But don’t take them out of habit. After your strep throat is over, you don’t keep taking penicillin—it’s the same thing with NSAIDs and pain.”
Mikhael agrees. “A lot of patients think that over-the-counter medication like Aleve and ibuprofen are absolutely safe to take and then they take it daily in a big amount,” he says. “Over-the-counter medications can be harmful when you take too much for too long a time.”
If you feel that you need to take NSAIDs for longer than a few days, Mikhael recommends checking in with your doctor to be safe. “Do not take it for granted that over-the-counter medication is safe simply because it’s over-the-counter,” he says. That said, if you need to take an ibuprofen for a few days for a random ache and don’t have an underlying heart condition, experts say you should be just fine to do so.