Painkillers pose problems for people with heart disease

Howard LeWine, M.D.

Chief Medical Editor, Harvard Health Publishing

As if people with the combination of high blood pressure and heart disease don’t already have enough to worry about, a new study suggests that common painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs) pose special problems for them.

Among participants of an international trial called INVEST, those who often used NSAIDs such as ibuprofen (Advil, Motrin and others), naproxen (Aleve, Naprosyn, and others), or celecoxib (Celebrex) were 47% more likely to have had a heart attack or stroke or to have died for any reason over three years of follow-up than those who used the drugs less, or not at all. The results were published in the July issue of the American Journal of Medicine.

Millions of people take NSAIDs to relieve pain and inflammation. They are generally safe and effective. The main worry with NSAIDs has always been upset stomach or gastrointestinal bleeding. During the last few years, researchers have raised concerns that their use may be hard on the heart as well.

This one study, and the handful that have come before it, don’t mean that people with high blood pressure and heart disease or other cardiovascular conditions should stop taking NSAIDs, especially if they are used to ease pain from a chronic condition like arthritis. But it may make sense to try an alternative first.

Talk with your doctor about taking aspirin instead of ibuprofen, naproxen, or other traditional NSAID. Aspirin eases pain and inflammation and also offers protection against myocardial infarction (heart attack) and the most common kind of stroke.

Try acetaminophen (Tylenol and many generic versions) instead of an NSAID. Be careful not to take more than 3,250 milligrams in a 24-hour period, and read medication labels—many combination over-the-counter products contain acetaminophen.

If aspirin or acetaminophen doesn’t give you enough relief, try a low-dose NSAID. Early studies suggested that naproxen it may be safer than ibuprofen, although this has been challenged.

If you take ibuprofen and aspirin, take the aspirin at least 30 minutes before the ibuprofen or eight hours afterward. Aspirin’s ability to protect the heart depends on its fitting snugly into the pocket of an enzyme known as cyclooxygenase. Ibuprofen can block aspirin’s entry into this pocket.


  1. Penny

    Thanks for the guidance and emphasis on nonsteroidal anti-inflammatory drugs (NSAIDs). There’s a lot to be said for following what you say.

    Certainly when I’m out on a walk (my greatest enjoyment is the great outdoors), I will be more sure than ever that natural remedies are so much more effective and available than the manmade versions.

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  3. Heather Smith

    This is simple. People who have heart problem should not take pain killers. Maybe there is a an alternative medicine that can control and help the heart problem. Best thing to do is to consult the specialist. Thanks for this post.

  4. Pamela Ritche

    Hi, provides helpful and accurate consumer health information about the side effects that typically arise from the use of prescription or over the counter medications, natural or health supplements and even certain types of food.

    Side Effects

  5. Jevaughn Brown

    For the last few years I’ve decided to say no to drugs – all drugs – unless I’m in the hospital and really need them for an emergency. But I don’t have a chronic pain condition to deal with. For those who use painkillers regularly this is another article that shows how important it is to get educated and stay up to date on the “side” effects of the painkillers you’re taking. Valuable information, especially the advice to read medication labels to judge how much acetaminophen you’re *really* taking in a day: Overdosing accidentally is so, so easy.

    Jevaughn Brown

  6. Jael

    Many people also use meditation to improve their health conditions. Since meditation can aid in relaxation, it can reduce stress and lower blood pressure. Meditating is a good way to forgo the tension of a bad day. It keeps the mind healthy, and a healthy mind helps lead to a healthier body. Some people even use meditation as their primary resource for medical care, using the power of their minds instead of the power of medicine.

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  7. Ray C

    Are there any alternatives to nsaids other than tylenol?

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  9. Daniel Muguko

    That is such a good piece of information on painkillers.We use them daily oblivious of their effects.


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