NSAIDs have been linked to an increased risk of serious heart conditions. People over age 65 with preexisting heart disease who take NSAIDs for a long time have the highest risk.

Nonsteroidal anti-inflammatory drugs, or NSAIDs, are a common type of medication used to relieve pain and fever. They’re available in both over-the-counter and prescription strengths.

NSAIDs have been linked to an increased risk of serious heart disorders, including stroke and heart attack. You have the highest risk if:

  • you’re over age 65
  • have preexisting heart conditions
  • have been taking NSAIDs for an extended period of time

Using alternative anti-inflammatory medication may sometimes be a safer option for people with multiple risk factors. Alternatives include topical diclofenac (Voltaren) or acetaminophen (Tylenol) for pain relief.

This article takes a closer look at how NSAIDs may increase your risk of heart disease and what you can do to minimize your risk.

Types of nonsteroidal anti-inflammatories

NSAIDs are available in both over-the-counter (OTC) and prescription strengths. Common NSAIDs include:

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Researchers have found a link between NSAIDs and an increased risk of heart attack and stroke.

Research in 2020 found that this risk is higher for people who already have heart disease. The risk also increases when an NSAID is taken at a higher dose or for a longer period of time.

This means that your risk is very small if you only take NSAIDs occasionally to treat a cold or headache. However, your risk increases if you take an NSAID daily for chronic pain.

There are two primary reasons that NSAIDs can affect heart health:

  1. NSAIDs change the way blood flows to your kidneys. This causes your body to retain fluids and salts, which in turn can raise your blood pressure and increase your risk of stroke and atrial fibrillation.
  2. NSAIDs can also raise the levels of certain chemicals in your blood that cause blood clots to form. This can make clots more likely, increasing your risk for a heart attack.

Typically, people under age 65 without any preexisting heart conditions have a very low risk of any heart complications from NSAIDs. However, the longer you take any NSAID, the greater your risk may be.

Since 2015, the Food and Drug Administration (FDA) has required that all NSAIDs include a warning label stating that the risk of heart attack and stroke can increase after just a few weeks of use.

There are a few ways you can lower your risk of heart events while you use NSAIDs.

The following recommendations offer a safer way to use NSAIDs for pain relief:

  • Take the lowest effective dose of any NSAID.
  • Only take as much as you need.
  • Take the medication for the shortest amount of time you can.
  • Try alternative pain relief methods, such as ice packs or elevating an injury.
  • Only use NSAIDs for acute, occasional pain. If you have chronic pain, talk with your doctor about alternatives.

There are other options that can help with the same symptoms that NSAIDs are typically used for. Some alternative treatments have their own side effects, though, and might not be right for everyone.

It’s best to reach out to a healthcare professional about the safest pain relief options for you.

Alternative to NSAIDs may include:

  • Acetaminophen: Acetaminophen, commonly under the brand name Tylenol, can reduce pain and bring down fevers. It’s available over-the-counter and in combination with medications that require a prescription. It can help with pain relief and fever, but it will not help with inflammation.
  • Topical pain relievers: Topical pain relievers are creams or gels you can massage into your skin for relief from muscle pain or arthritis. It’s important to read labels because some topical pain relievers do contain NSAIDs.
  • Massage: A massage can help relieve pain for some people, without any medication side effects.
  • Ice and heat: Temperature-based treatments, such as ice packs, hot baths, and steam, can help reduce pain.
  • Physical therapy: Physical therapy can help strengthen sore muscles, leading to pain relief.
  • Lifestyle changes: Sometimes, chronic pain can be reduced with lifestyle changes such as weight loss and increased exercise.
  • Yoga: Many types of exercise can help reduce pain, but yoga is often specifically tailored for pain relief.
  • Complementary or alternative medicine: Many people report pain relief from alternative pain-relieving options such as arnica, curcumin, and bromelin, and from treatments such as acupuncture.

NSAIDs can help relieve pain. They can also increase the risk of serious heart health issues, including stroke and heart attack.

This risk is greatest for people with preexisting heart conditions and people who take high doses of NSAIDs for a long time.

Alternative pain relief options, such as acetaminophen, can be a better choice for certain people with preexisting heart issues. However, some alternative pain relievers have their own side effects and risks. It’s a good idea to talk with your doctor about what pain relief option is safest for you.