BOSTON, MA — Cardiovascular side effects aren't limited to the use of the newer painkillers called COX-2 inhibitors-a category that includes Celebrex and the recently discontinued Vioxx and Bextra. Old standbys, like ibuprofen and aspirin, aren't entirely blameless, reports the October 2006 issue of the Harvard Heart Letter. The cardiovascular risks associated with traditional NSAIDs are small, but worth being aware of.

Ibuprofen, aspirin, and COX-2s all belong to the class of medicines called nonsteroidal anti-inflammatory drugs (NSAIDs). Most of them boost blood pressure and can counteract the effect of some blood-pressure drugs. They can also impair blood vessels' ability to relax and may stimulate the growth of smooth muscle cells inside arteries. All these changes can contribute to the artery-clogging process known as atherosclerosis.

Researchers have determined that use of a COX-2 inhibitor increases the chances of having a heart attack. Vioxx, which was taken off the market because of possible heart complications, may lead to or worsen heart failure-but so can traditional NSAIDs. In general, cardiovascular side effects are most likely to happen in people with existing heart disease or those at high risk for it.

The Heart Letter offers a simple table to help people make an informed choice about pain relievers. That choice depends in part on whether you are also taking aspirin to protect your heart. If NSAIDs upset your stomach, try taking them along with an acid blocker. If you don't get relief from a traditional NSAID and you don't have heart disease or its risk factors, don't rule out a COX-2 inhibitor.