Which NSAID is Safest for Your Heart?
Multiple studies have shown that people should take precautions when using nonsteroidal anti-inflamatory drugs (NSAIDS) to relieve pain, fever and inflamation because of the drugs’ well-known cardiovascular risks.To answer the question of how to choose the safest for various individuals, a group of scientists examined how various NSAIDs compared against each other when it came to heart safety. They published their findings in the journal PLoS Medicine from the Public Library of Science.These researchers pooled data from observational studies of 2.7 million people at both high and low risk for cardiovascular disease. This allowed them to gather data about individual drugs and their risks when used in settings other than those in controlled clinical trials. The downside of observational studies is that a true cause and effect can’t be established since other factors may influence results. The study also took into consideration the varying lengths of time people took NSAIDs in home settings rather than clinical trials.What can considered unique about this meta-analysis is that it included people taking low and over-the-counter doses of NSAIDs. Most other meta-analyses have studied results that involved higher prescription doses.Both prescription and nonprescription naproxen was deemed the least likely NSAID to raise cardiovascular risk, with over-the-counter (OTC) ibuprofen a close second. The two NSAIDs with the highest risks are either no longer on the market (rofecoxib[Vioxx]) or not available in the United States (diclofenac).Among low-risk people who take NSAIDs, the chance of a heart attack or other adverse cardiovascular event is small, and an occasional NSAID should cause no harm; however, NSAIDs significantly increase the risk of such and event in people with underlying heart disease and should be avoided whenever possible.

If you take NSAIDs for a prolonged period, talk to your doctor about the risks. Over time, large doses of NSAIDs can do damage to the kidney, a condition known as nephrotoxicity.

Individuals may also be susceptable to gastric distress that NSAIDs can cause. On average, people taking NSAIDs are four times more likely to develop gastrointestional complications such as bleeding and ulcers. Always take the lowest effective dose, and never exceed the maximum recommended dose unless instructed by your doctor.

The following information is from the table of findings relating to individual NSAIDs: NAPROXIN is sold under the brand names ALEVE, ANAPROX, NAPRELAN, AND NAPROSYN. The findings indicate that both prescription and over-the-counter (OTC) doses are safest among NSAIDs for both high and low risk individuals. IBUPROFIN is sold under the brand names ADVIL, MOTRIN AND NUPRIN and low doses of OTC are safest, but as prescription doses rise above 1,200mg a day, so does cardiac risk. CELEOXIB is sold under the brand name CELEBREX and both high and low doses shoed a slightly increased cardiac risk, and the study authors say they would be “reluctant” to prescribe it to high-risk patients. INDOMETHACIN is sold as INDOCIN and is considered high risk given its gastrointestinal and nervous system risks and the authors advise removing it from the market. PIROXICAM is sold under the brand name FELDENE. The risk is similar to that of Naproxen, but it has a very high risk of serious gastrointestinal disturbances. MELOXICAM is sold as MOBIC and has risks similar to that of ibuprofen and celeoxib, but it should be avoided by high-risk persons. ETODOLAC is sold under the brand name LODINE. Sparse date make this a questionable choice. When compared with naproxen and ibuprofen, risk was similar, but on its own, some studies found it to be high isk.

Johns Hopkins Medicine, Health After 50 Volume 24, April 2012

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