Locations:
SearchThe short answer from an interventional cardiologist
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.
Advertisement
The little blue pill might help with physical arousal, but there are better treatments for low libido in women
Your body’s response to rapid weight loss from the medication may cause shedding
This medication is best used on a limited basis
Authorized take-back programs, services and drop-off locations are the best, safest way to get rid of expired medicine
These illegal supplements have negative impacts for vital organs and may cause psychosis, heart attacks and more
These creams that you apply to your skin can actually help reduce localized pain, swelling and inflammation
Popular among teens, these inhalants give you a quick high, with serious harmful effects
‘Black box warnings’ on medications outline potential risks and important instructions
Start having sex about 72 hours before ovulation, then at least every other day during your fertile window
Attachment theory suggests that your earliest relationships shape connections throughout your life
It isn’t a recognized mental health disorder, but research shows that problematic social media use can negatively affect your mental health, self-esteem and sleep
