Locations:
Search IconSearch

How Safe Are NSAIDs for Someone Who Has Had a Heart Attack?

The short answer from an interventional cardiologist

Older woman taking aspirin for pain instead of NSAID

Q: I have osteoarthritis and need to take something for pain relief. How safe are non-steroidal medications for someone who has had a heart attack?

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

A: In this era of growing concern over opioids, individuals with osteoarthritis (OA) and rheumatoid arthritis (RA) commonly use nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief.

After the NSAID rofecoxib (Vioxx) was found to increase the risk of heart attack and stroke, adverse cardiovascular (CV) events from other NSAIDs have remained a concern. Clinical studies suggest NSAIDs may, indeed, increase CV events. However, this risk varies and should be assessed relative to the value of pain control.

The PRECISION trial demonstrated that celecoxib (Celebrex®) at recommended doses was not associated with an increased rate of CV events, compared with maximum titrated doses of over-the-counter naproxen (Aleve®) and ibuprofen (Advil®, Motrin®).

A subsequent analysis found that gastrointestinal, kidney and other side effects were 20% more common with naproxen and 38% more common with ibuprofen than celecoxib. NSAID toxicities were not significantly different by age, sex, type of arthritis, tobacco use or history of ulcers, but were higher among patients with diabetes and those who were not taking aspirin.

OA patients appeared to respond equally to all three types of pain relievers, while RA patients responded slightly better to ibuprofen. Although no comparison was made to placebo, the overall message was that all three drugs can help improve quality of life in arthritis patients with reasonable safety.

Advertisement

Starting with a 100- to 200-mg dose of celecoxib may be the safest choice in patients with CV disease. If celecoxib does not produce adequate pain relief, naproxen or ibuprofen should be considered.

Choosing a medication based on your medical history and risk factors, while continuing low-dose aspirin and, possibly, a proton pump inhibitor may minimize your risks when pain control is necessary.

— Interventional cardiologist Leslie Cho, MD

Advertisement

Learn more about our editorial process.

Related Articles

Hand squeezing cream from a tube onto a finger
April 24, 2025/Orthopaedics
Are Topical Anti-Inflammatory Creams Worth the Rub?

These creams that you apply to your skin can actually help reduce localized pain, swelling and inflammation

Containers of medications with black box warning labels
January 17, 2025/Primary Care
What Is a ‘Boxed Warning’ on Medications?

‘Black box warnings’ on medications outline potential risks and important instructions

Assorted bottles of Rx medications with pills and capsules around
January 13, 2025/Primary Care
What Is a Generic Medication?

These similar versions of brand-name drugs are safe, effective and often less expensive

Hands selecting medicine from shelves of medicines
December 4, 2024/Primary Care
How Do Medicines Get Their Names?

Drugmakers put a lot of effort and resources into finding the right name for generic and brand medications

Variety of medication pills and tablets and liquids
February 22, 2024/Primary Care
Is It OK To Take Expired Medicine?

Some types of expired meds may not be harmful, but they probably aren’t worth the risk

person packing medication for suitcase
September 8, 2023/Wellness
What To Know Before Take-Off: Packing Medications for Vacation

Make it easy on yourself by checking airline regulations and keeping meds in your carry-on

Mother and child checking cough syrup in their medicine cabinet.
January 13, 2023/Primary Care
What To Keep in Your Medicine Cabinet

Essential over-the-counter items for the illnesses and ailments of life

Splitting pills
March 7, 2022/Primary Care
Is It Safe To Split Pills?

Cutting pills is a normal — and potentially dangerous — practice

Trending Topics

Person in bed sleeping on their side, covers off
Breathing Problems? Try These Sleep Positions

If you’re feeling short of breath, sleep can be tough — propping yourself up or sleeping on your side may help

A couple looking at skyline, with one person slightly behind the other, head bent down
What Is Anxious Attachment Style — and Do You Have It?

If you fear the unknown or find yourself needing reassurance often, you may identify with this attachment style

Glasses and bottle of yellow-colored prebiotic soda, with mint, lemon and ginger garnish
Are Prebiotic Sodas Good for You?

If you’re looking to boost your gut health, it’s better to get fiber from whole foods

Ad