NSAIDs (nonsteroidal anti-inflammatory drugs) have become a staple in our homes, and the traditional medical community pushes them for everything from simple musculoskeletal pains, sprains, and injuries to disorders like arthritis. They’ve become so commonplace in our medicine cabinets that most people reach for an Aleve or a Motrin for a small headache like they’d reach for a Band-Aid to cover a bleeding wound. But the truth is NSAIDs are high-risk drugs that have been linked to a number of serious issues, including GI bleeding, Alzheimer’s disease, and sudden death due to heart attack or stroke. We’ve covered many of the risks over the years, and now there’s new evidence of heart failure due to NSAIDs.
Before we dig into the newest study, let’s review what NSAIDs are and some of the risks we’ve shared in the past.
NSAIDs: What Are They and What Do They Do?
Most NSAIDs are purchased right over the counter, and these are the ones you are likely most familiar with. These include ibuprofen (e.g., Advil and Motrin), naproxen (Aleve), and even aspirin. There are also many NSAIDs that require a prescription. Examples of these include celecoxib (Celebrex) and meloxicam (Mobic). While each NSAIDs has a different risk profile, all carry high risks for serious side effects.
While it’s pain that may cause us to open up the medicine cabinet and reach for an NSAID, what sets NSAIDs apart from acetaminophen (e.g., Tylenol), for example, is their anti-inflammatory properties. If you have a painful swollen ankle, an NSAID will tackle both the pain and the swelling while acetaminophen will only address the pain. On the surface this may seem like a positive on the pro side of NSAIDs; however, acute inflammation (swelling following an injury) is your body’s way of addressing and healing the injury. So not only do NSAIDs introduce the potential for high-risk side effects, but they are also counterproductive as they blunt the body’s natural healing process.
More on Inflammation
In contrast to the acute inflammation that our body can handle, chronic inflammation is more insidious. Contributors to chronic inflammation are aging; lack of exercise; consuming too much sugar, processed carbohydrates, and other inflammatory foods; and weight gain. This type of inflammation isn’t beneficial, and it can lead to serious health conditions and chronic middle-aged aches and pains. Regular exercise can keep pro-inflammatory chemicals in check. Avoiding NSAIDs and substituting with supplements such as curcumin, glucosamine and chondroitin, and fish oil can provide some relief without the dangerous side effects. Cutting sugar and other inflammatory foods can also provide relief or even preempt the onset of chronic inflammation if it hasn’t already set in. Even if it has, It’s never too late to start dousing the fires of inflammation.
The Cons of NSAIDs
There may be some very extreme cases where the powerful punch of NSAIDs may outweigh the serious risks; however, the list of cons is long and continues to grow. Let’s review some of these.
- One-half to one-third of one study’s subjects, who’d taken NSAIDs for greater than one month, had damage to their gastrointestinal tract. Researchers concluded that NSAID use carries a “significant risk of small bowel injury.”
- NSAIDs increase the risk of a second heart attack within five years of a first heart attack.
- NSAIDs increase the risk of dying from a heart attack by up to 407%, depending on the NSAID.
- NSAIDs increase the risk of dying from a stroke by as much as 53%, depending on the NSAID. In addition, NSAIDs increase the risk of having a stroke by up to 336%, depending on the NSAID.
- One study shows that NSAIDs actually make arthritis worse, not better.
- NSAIDs may disrupt stem cell function, cartilage, bone formation, and healing.
- Links have been established between NSAIDs and Alzheimer’s disease.
In addition, the American Heart Association (AHA) issued warnings on the high risks of NSAIDs and joined forces with the Alliance for Rational Use of NSAIDS, a public-health coalition. The Food and Drug Administration (FDA)also issued stern warnings about the dangerous heart attack and stroke risks associated with NSAIDs. Over-the-counter NSAID labels already carry the warning of GI bleeding, but the FDA warning also required prescription NSAID labels to carry the warning of heart attack and stroke risks.
The New Study on Heart Failure Due to NSAIDs
The new study was a multimillion-subject study looking at the numbers of hospital admissions for heart failure accompanied by NSAID use. Data from 2000–2010 from four countries (UK, Italy, Germany, and the Netherlands) were studied. The results varied depending on the NSAID, with risks for heart-failure admission as much as doubling for some NSAIDs (e.g., diclofenac, indomethacin, and rofecoxib), but on the whole, there was a 19% increase in risks for heart-failure admission when the subjects were also taking NSAIDs.
The upshot? Many people become dependent on NSAIDs for normal functioning. Just the idea of getting off them can be difficult to consider. I see many patients who fall into this trap. They are typically physically active patients who feel they can only stay active by keeping their pain in check with NSAIDs. But with the added risks of heart failure due to NSAIDs, and so much more, it’s just not worth it. There are ways to end your dependence on NSAIDs—read “Are You an NSAID Addict? What Can You Do?”—and say no to the long list of dangers.