NSAIDs and heart failure: what’s the link?

Non-steroidal anti-inflammatory drugs (NSAIDs) are popular and highly effective pain relievers, but despite their widespread use, they do carry risks.

NSAIDs are known to have various side effects, including gastrointestinal bleeding, cardiovascular side effects, and NSAID-induced Nephrotoxicity (rapid deterioration of the kidneys). Most notably, these common pain relievers can increase your risk of heart failure, especially if you’ve had a heart attack in the past.

This article will focus on the role of NSAIDs in heart failure and shed light on specific NSAIDs that may put you at higher risk for heart-related medical complications.

What are NSAIDs?

Non-steroidal anti-inflammatory drugs (NSAIDs) are medicines commonly used to reduce pain and reduce fever.Available over the counter and by prescription, these drugs work by reducing levels of pro-inflammatory chemicals prostaglandin.

NSAIDs are used to treat a variety of conditions that cause inflammation, mild to moderate pain, and fever, including:

  • Headaches and migraines (recurrent headaches with moderate or severe pain)
  • colds and flu
  • sports injuries, such as sprains and strains
  • Arthritis (swelling and pain in the joints), rheumatoid arthritis (RA, an autoimmune disease that affects the joints), and other musculoskeletal disorders
  • menstrual cramps
  • postoperative pain

Long-term use of NSAIDs for chronic pain and potential side effects

List of anti-inflammatory drugs

NSAIDs are among the most widely used, inexpensive, and widely used drugs in the world. Some commonly used NSAIDs include:

  • Bayer (aspirin)
  • Motrin and Advil (ibuprofen)
  • Naproxen and Aleve (naproxen)
  • Volta (Diclofenac)
  • Celebrex (Celecoxib)
  • Tivobex (Indomethacin)
  • Mobic (Meloxicam)
  • Clint Riel (Sulindac)
  • Fayden (Piroxicam)

Some pharmaceutical companies even combine NSAIDs with other anti-inflammatory drugs to treat pain associated with specific conditions. For example, the drug Excedrin combines acetaminophen, aspirin, and caffeine to treat migraines.

what is the difference? Motrin, Aleve, Tylenol and Aspirin

How NSAIDs Work

Prostaglandins are hormone-like chemicals in the body that cause inflammation, pain, and fever by raising body temperature and dilating blood vessels. This can cause redness and swelling where they were released.

Prostaglandins have a bad reputation because they make us feel bad when we are sick. In fact, they are vital to our health because they protect the stomach and intestinal lining from acid damage, promote blood clotting by activating platelets, and allow the kidneys to function optimally.

When the body is in trouble, it goes into a pro-inflammatory state in search of a solution. This can cause us to feel pain and fever, prompting us to take NSAIDs.

NSAIDs work by blocking enzymes cyclooxygenase (or COX), which is used by the body to make prostaglandins. The two types of COX enzymes are:

  • COX-1 has been present in most tissues.
  • COX-2 is mainly expressed in inflammatory responses.

Both COX-1 and COX-2 produce prostaglandins that cause pain and inflammation, but COX-1 produces a group of prostaglandins that protect the stomach lining from acid and are an important part of the blood clotting process.

Traditional NSAIDs, such as Motrin (ibuprofen), aspirin, and Aleve (naproxen), block both COX-1 and COX-2. These should be taken with caution as they can cause ulcers and increase the risk of gastrointestinal bleeding. This is especially true when inhibition of COX-1 results in a severe reduction in systemic prostaglandin synthesis.

Safer Alternatives to NSAIDs

What is the link between NSAIDs and heart failure?

If you have a history of cardiovascular disease or a weakened left heart (called left ventricular dysfunction), taking NSAIDs may worsen your heart failure.

This is because NSAIDs impair kidney function (the ability of the kidneys to work) by inhibiting the production of prostaglandins.As a result, water and sodium are retained and blood flow to the kidneys is reduced (at a lower glomerular filtration speed).

NSAIDs can worsen kidney function, thereby disrupting the homeostasis (balance) of the cardiovascular system.Retained fluid can overwhelm a weakened heart, a phenomenon called cardiac decompensation. Cardiac decompensation impairs the ability of the heart to pump blood, as well as worsening kidney function due to poor blood flow.

Which NSAIDs increase the risk of heart failure?

Not all NSAIDs are good for heart problems. For example, aspirin is sometimes used as a blood thinner and may have a protective effect on the heart. NSAIDs that pose the greatest risk include:

Ibuprofen: Studies have found that ibuprofen, such as Advil and Motrin, can worsen existing high blood pressure (hypertension) or lead to the development of high blood pressure. These drugs have also been linked to kidney damage (nephrotoxicity), worsening heart failure, and even heart attack or stroke.

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COX-2 inhibitors: When more COX-2 is blocked relative to COX-1, it increases the risk of blood clots (thrombosis).This in turn increases the risk of adverse Cardiovascular thrombosis event. Among traditional NSAIDs, Voltaren (diclofenac), Celebrex (celecoxib), and Mobic (meloxicam) are relatively selective for COX-2.

Does the dose matter?

A general rule of thumb is that if you need medication, use the lowest effective dose of an NSAID for the shortest possible time. If you have heart failure, use NSAIDs only as directed by your healthcare provider.

How about OTC ibuprofen?

If you have a history of diabetes, high blood pressure, or heart failure, be sure to discuss the use of over-the-counter ibuprofen with your healthcare provider. Regular use of over-the-counter ibuprofen can cause or worsen heart failure, although most people can usually use ibuprofen as needed for pain relief.

Should I take NSAIDs if I already have heart disease?

Current heart failure treatment guidelines recommend avoiding NSAIDs because they can cause sodium retention and vasoconstriction (narrowing of blood vessels).These drugs can also reduce effectiveness and increase toxicity ACE inhibitor and diuretics.

When to seek medical assistance

If you are taking NSAIDs and feel any new signs or symptoms, such as fatigue, dizziness, headache, shortness of breath, or pain in your abdomen, chest, or back, you may have a medical experience with NSAIDs complication. Even if you don’t think your symptoms are life-threatening, you should seek medical attention right away.

If you have any of the following symptoms, whether or not you’ve taken NSAIDs, you may have a heart attack or stroke. Call an ambulance or someone to take you to the emergency room immediately if you experience:

  • new or worsening chest pain
  • chest discomfort, feeling like someone is sitting on your chest
  • sudden slur
  • Weakness in one part or side of the body


By reducing the production of prostaglandins, NSAIDs help relieve the discomfort of fever and reduce pain associated with inflammation. But if overused, they can cause or worsen heart failure, especially in people at high risk for cardiovascular disease, such as those with diabetes or high blood pressure, and in those with a history of heart failure.

VigorTip words

NSAIDs are some of the most commonly prescribed and over-the-counter medicines in the world, but studies show they can raise blood pressure, damage the lining of the stomach and kidneys, and worsen heart failure.

If you have high blood pressure, diabetes, or a weakened heart, consult a healthcare professional before using these medications. Short-term, occasional use is probably safe for most people, but be sure to check your blood pressure regularly and try to stop using it as soon as possible.

Frequently Asked Questions

  • How do NSAIDs trigger congestive heart failure?

    NSAIDs can impair kidney function, causing water and sodium retention. The retained fluid can overwhelm the heart, a phenomenon called cardiac decompensation. Cardiac decompensation impairs the heart’s ability to pump blood, while kidney function deteriorates due to poor blood flow, creating a vicious cycle.

  • Can I take NSAIDs for heart failure?

    Yes, but you should do so under the guidance of a healthcare professional. Not all NSAIDs are bad for your heart. In fact, some studies have found that taking a baby aspirin a day (81 mg, about a quarter of an adult dose) may help your heart, though these claims have recently come under fire.

    If you experience pain, some healthcare providers may recommend taking regular, regular aspirin in the lowest possible dose and for the shortest time possible, while others may recommend Tylenol (acetaminophen) from another drug class ) to relieve pain.

  • Which Medications Should I Avoid for Heart Failure?

    Patients with heart failure should avoid ibuprofen, naproxen, and selective COX-2 inhibitors such as diclofenac, celecoxib, and meloxicam.