July 9, 2014
News Review From Harvard Medical School -- Study Raises Heart Concerns for Naproxen
Another study has added to the debate about whether some common pain relievers can increase the risk of heart attack and stroke. The new study looks at nonsteroidal anti-inflammatory drugs (NSAIDs). Many people take aspirin, one type of NSAID, to help prevent heart attacks. But the others carry a label warning about a possible increased risk of heart attacks. NSAIDs include ibuprofen (Motrin, Advil and generics) and naproxen (Naprosyn, Aleve and generics). They also include the prescription drug celecoxib (Celebrex). The new study looked at the use of NSAIDs in 160,000 older women. They were part of the Women's Health Initiative study. That study looked at older women's use of hormone therapy. But it also recorded all of the medicines they took. The new study found a higher risk of heart attack and stroke among women who used naproxen or celecoxib. There was no increased risk with use of ibuprofen. Some prior studies have suggested that risk may be greater with ibuprofen than with naproxen. The journal Circulation: Cardiovascular Quality and Outcomes published the study. HealthDay News wrote about it July 8.
By Howard LeWine, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
When your joints ache or your head throbs, you might turn to aspirin, ibuprofen (Advil, Motrin) or naproxen (Aleve) for pain relief. They are known as nonsteroidal anti-inflammatory drugs (NSAIDs). Millions of Americans rely on these and other NSAIDs every day.
NSAIDs are so widely used because they perform double duty. They relieve pain and also reduce inflammation.
All NSAIDs have been linked to a greater risk of heart attacks, strokes and heart-related deaths. But naproxen has appeared to pose the least risk, until now. This current research suggests that the heart attack and stroke risk for naproxen might not be any lower.
However, the results of this research need to be viewed with caution. The authors analyzed old data from a very large study called the Women's Health Initiative. The study was originally designed to evaluate the effectiveness and safety of hormone therapy in women after menopause. It was not designed to look at the safety of NSAIDs.
This study included more than 160,000 women. Researchers collected many details about the women, including diet, exercise and medicine use. The vast amount of data has been analyzed dozens of times to look for links between behaviors and outcomes unrelated to hormone use. In this instance, researchers discovered a link to higher rates of heart attack and stroke for all NSAIDs other than aspirin.
The two most popular NSAIDs are ibuprofen and naproxen. The surprise from this study was the higher risk of heart attack and stroke in naproxen users compared to ibuprofen users.
What Changes Can I Make Now?
This report won't change the advice I give my patients.
The safest way to help ease muscle or joint pain is a non-drug approach. Try heating pads, ice and physical therapy. Even if they don't completely do the trick, they may at least let you cut back on how often you take a pain reliever or how much you take.
If you are just looking for pain relief, try acetaminophen first. Acetaminophen kills pain in a different way than NSAIDs. It doesn't increase heart attack risk. And it doesn't irritate the stomach. But acetaminophen does not calm inflammation.
In high doses, acetaminophen can cause liver damage. A safe dose for most adults is no more than 3.25 grams per 24 hours (10 regular-strength or 6 extra-strength acetaminophen tablets per day).
Don't forget about aspirin. It's a very effective pain reliever and dampens inflammation. And aspirin is the one NSAID that helps prevent heart attacks and strokes. If you need to take more than an occasional aspirin, check with your doctor about the right dose for you.
These strategies may not work for you. You may need an NSAID. Occasional use of any of them is likely to be fine. But if you have heart disease or have had a stroke, check with your doctor first. People with kidney disease, stomach ulcers or a history of internal bleeding should avoid NSAIDs.
If you take a daily aspirin tablet to prevent clotting and also take an NSAID, take the aspirin first. Wait an hour to take the NSAID. Take both with a little food.
What Can I Expect Looking to the Future?
The controversy about which is the safest NSAID other than aspirin will continue.