Naproxen and ibuprofen, common pain relievers called non steroidal anti-inflammatory drugs, or Nsaids are hugely popular drugs for arthritis, pulled muscles, menstrual cramps and of course headaches. While their labels warn that overusing them may increase the risk of stroke and heart attack, people depend on them because they are effective.

Compelling new research that has incorporated data from over 600 trials concludes that daily, high doses of Nsaids can increase one’s cardiovascular risk by as much as a third, compared with taking a placebo. However, there is an exception – naproxen may actually have a protective effect against heart attacks. While the outright risk of cardiovascular problems for those taking high doses of other Nsaids routinely is still small, the findings propose that people may want to look into alternative pain management plans – especially if there is a family history for heart disease, or if there are other risks for it.

“There aren’t really good choices for chronic pain,” said Dr. Marie R. Griffin, a preventive medicine specialist at Vanderbilt University Medical Center. “If these drugs are making your life a lot better, that may be worth the risks,” she said. “But a lot of people will tell you, ‘I can’t tell if they’re doing anything, I just take them every day anyway.'” Nsaids include ibuprofen, sold under the brand names Motrin and Advil; naproxen, sold as Aleve, Naprosyn, Anaprox and Naprelan; and celecoxib, sold as Celebrex and sold by prescription only. Aspirin, which is also an Nsaid, and mainly used in low doses to prevent heart disease was not part of the study.

Some doctors are concerned that focusing on the cardiovascular risks will influence people to stop taking Nsaids, though statistically they will unlikely be harmed by them, and they control their pain. “People get very worked up about the cardiac risks, and they are real,” said Dr. Brian Walitt, a rheumatologist and associate professor at Georgetown University. “But these are population-wide risks. There are people with arthritis using these drugs every day, or most days, and most of them never have a problem.”

Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic offers some advice for people who feel they need to take Nsaids daily. “Our advice has always been, use the lowest dose you can for the least amount of time you can.” If you have heart disease, or risk factors for it, have your doctor assess the risk of chronic Nsaid use based on your medical history, and that of your family history. Any gastrointestinal issues should also be looked at……….   nytimes.com     6/17/13

 

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