• Some Pain Drugs Increase the Risk of Heart Attack

ROCHESTER, Minn. — Some of the most common pain drugs used by older adults who experience discomfort in muscles and joints can increase the risk of heart attack and stroke.

The April issue of Mayo Clinic Health Letter covers the risks of nonsteroidal anti-inflammatory drugs (NSAIDs) that include celecoxib (Celebrex), diclofenac (Voltaren), ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve). These medications often are associated with stomach ulcers and bleeding or kidney problems. Another downside is that these drugs increase the risk of cardiovascular problems.

For those without a history of cardiovascular disease, most common pain medications are generally quite safe if taken at or below the recommended dosage for a short time. The risk of cardiovascular problems may climb when these medications are taken over a longer period and at higher doses. NSAIDs appear to provide the highest risk for those who have had a heart attack or have established cardiovascular disease. Research indicates that, over five years, NSAID users who have had a heart attack are 63 percent more likely to die and 41 percent more likely to have another heart attack than nonusers.

Even short-term use may significantly increase risk. For patients who have had a heart attack, the risk of a second heart attack increases as soon as they start taking diclofenac and within a week or two of taking ibuprofen. For patients taking celecoxib, the risk increases after a few weeks of therapy.

The risk of naproxen is lower than that of other NSAIDs, although stroke risk may increase. Aspirin lowers the risk of a dangerous blood clot, so it is a safer option. Acetaminophen (Tylenol, others) doesn't increase the risk of heart attack.

Patients with cardiovascular disease are advised to work closely with a doctor to determine alternate ways to reduce muscle and joint pain, such as avoiding joint aggravation, maintaining a healthy weight, reducing stress, using warm soaks or cold packs, and developing an exercise plan with a physical therapist.

Mayo Clinic Health Letter is an eight-page monthly newsletter of reliable, accurate and practical information on today's health and medical news. To subscribe, please call 800-333-9037 (toll-free), extension 9771, or visit Mayo Clinic Health Letter Online.

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