Advertisement
The 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, gender, 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.
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
Factors like temperature, energy levels and sleep quality play a role in determining whether working out in the morning or evening is best for you
Obesity, age and preexisting heart conditions can all raise your risk of cardiovascular disease during pregnancy
Xylitol in processed food can increase risk of heart attack and stroke — but there’s no danger in xylitol in oral care products
If your provider has ruled out a serious cause, you can treat chest pain at home with antacids, inhalers or anti-inflammatory medications
Walking is a great goal, but how many steps are best for you depends on factors like your fitness level and age
Research shows a strong association between rheumatoid arthritis and heart issues
The scenarios vary based on how many pills you’ve missed and whether you take a combination pill or progestin-only pill
Eating more natural, whole foods can lower your risk of heart and cardiovascular diseases
Focus on your body’s metabolic set point by eating healthy foods, making exercise a part of your routine and reducing stress
PFAS chemicals may make life easier — but they aren’t always so easy on the human body
While there’s little risk in trying this hair care treatment, there isn’t much science to back up the claims