Have a little pain, take a Ibuprofen (Advil) right? Joints hurting after exercise? Pop an Naproxen (Aleve). They are a pretty safe pain reliever right? Doctors have their patients taking them like they are pez candies some times. There have been reports for quite a while describing some cardiac issues that can arise from use of NSAIDs but it would seem people are starting to take notice.

Source

I'd bet you might have seen this discussed elsewhere in the news recently, but if not lets have a very brief chat about some work published in the European Heart Journal: Cardiovascular Pharmacotherapy titled "Non-steroidal anti-inflammatory drug use is associated with increased risk of out-of-hospital cardiac arrest: a nationwide case–time–control study"

What Is An NSAID?

An NSAID, or Non-Steroidal Anti Inflammatory Drug that provide three properties to people who take them, analgesic (which is the fancy medical term for pain killing), antipyretic (more medical lingo, this time it means fever reducing), and also anti-inflammatory (HAHA! not so fancy with this term eh medical doctors!).

NSAIDs accomplish these functions through inhibiting two enzymes throughout the body called cyclooxygenases-1 and -2. You may be more familiar with their abbreviated names COX-1 and COX-2. These two enzymes are involved in the generation of a different hormone molecule called a prostaglandin, which is responsible for regulating a variety of cellular pathways including controlling inflammation levels.

These drugs are some of the most commonly used in the world, with up to 27 million people in the US alone reporting using them on a regular basis.^[2]

There are two classes of NSAIDS those that non selectively inhibit the COX enzymes, and those that selectively inhibit only COX-2. The variety of NSAID people previously thought to be most relevant to cardiac health (thought to be correlated to an increased chance of stroke and heart failure) were those that non-selectively inhibit the COX enzymes.^[3] However the authors of this article state that despite all of the previous evidence there were no clear studies showing a correlation between use of NSAIDs and heart attacks (cardiac arrest).

WHY DID I TAKE THAT ADVIL???

So they set out to see if there was or was not one based upon data from Denmark.

Results of the Study

• Ibuprofin (a non selective COX inhibitor) was the most common NSAID taken (51% of people in the databases).
• The use of ANY NSAID was associated with an increase in the risk of a heart attack (increased risk by about 17-49% with 95% confidence)
• Most of this risk came from non selective COX inhibitors (Such as Ibuprofen aka Advil), they increased the risk 18-48% with 95% confidence. However no significant correlation was found for Naproxen (Aleve) despite it also being a non specific NSAID.
• NSAIDS selective for only inhibiting COX-2 (like celebrex) did NOT show a strong relationship to heart attacks like the Ibuprofen did.

What Should We Think About This?

The research indicates that Ibuprofen especially has a negative effect on the heart, and supports other previous studies indicating similar findings. I am not going to make any recommendations on how you should live your life, however it is always good to know about the potential risks associated with any drug we put into our bodies. Hopefully findings such as this will encourage more research into other methods of pain control that may not have such significant cardiac effects.

There is always Tylenol (acetaminophen) which is not classified as an NSAID as it does not have the same anti inflammatory effects, and is specific for COX-2, which would likely place it in the category with the other COX-2 specific drugs that do not have the adverse heart health effects. However, if you take this one you likely want to avoid any consumption of alcohol as the combination of the two can lead to severe liver and kidney damage.^{[4], [5]}

Sources

1. https://academic.oup.com/ehjcvp/article/3/2/100/2739709/Non-steroidal-anti-inflammatory-drug-use-is
2. https://www.ncbi.nlm.nih.gov/pubmed/23723142
3. https://www.ncbi.nlm.nih.gov/pubmed/15705456
4. http://www.medscape.com/viewarticle/814484
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014937/

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