How to choose a pain reliever if you have heart disease

People with chronic conditions, such as heart disease, always have to be careful about what medications they take—and that includes over-the-counter drugs and herbal supplements, too. I always start each office visit with a review of what medications a patient is taking. If your doctor forgets to ask about over-the-counter medications, vitamins, or supplements, bring up the subject yourself. And if you have heart disease and wonder what medication you should take for chronic aches and pains, like those caused by arthritis or a bad back, read on.

The below article was first published in the Harvard Heart Letter, and it offers research-backed advice about heart disease and pain killers. The study reported in the article followed a lot of people for many years, making its data powerful. That said, it’s just one study, and there is no consensus as to whether any one nonsteroidal anti-inflammatory drug (NSAID) is the safest for people with heart disease. And in any case, you should always talk to your doctor before starting any medication.

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For long-term pain relief, most people reach for an over-the-counter painkiller like aspirin, acetaminophen (Tylenol, generic), ibuprofen (Motrin, generic), or naproxen (Aleve, generic). Some rely on prescription drugs such as celecoxib (Celebrex). A recent study supports the idea that one of these—naproxen—is easiest on the heart.

Aspirin, ibuprofen, naproxen, and Celebrex belong to the family of drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs). It’s been known for years that they can upset the stomach and cause bleeding in the digestive tract. The sudden removal of Vioxx (a close relative of Celebrex) from the market in the fall of 2004 turned a spotlight on possible complications elsewhere: in the heart and arteries. Since then, researchers have been trying to figure out if one NSAID is easier on the heart than the others.

A team led by researchers at Vanderbilt University School of Medicine combed through the medical records of nearly 50,000 men and women hospitalized with a heart attack or unstable angina, or for angioplasty or bypass surgery. They determined which ones regularly used NSAIDs over the next two years, and which ones had a repeat heart attack, a stroke, or died of heart disease.

Those who regularly took naproxen had fewer heart-related events than folks who rarely used NSAIDs. Celebrex appeared to have little or no effect on the heart. Users of ibuprofen, Vioxx, and diclofenac (an NSAID used mainly in Canada and the United Kingdom) had more cardiovascular events than non-NSAID users (Circulation: Cardiovascular Quality and Outcomes, May 2009).

Because NSAIDs act throughout the body, focusing solely on the heart doesn’t offer the full picture of their effects. In fact, people taking Vioxx were less likely than other NSAID users to have died during the study period. This raises the possibility that the drug may have prevented some episodes of severe gastrointestinal bleeding. It also makes the point that it’s important to focus on the overall safety of NSAIDs and other medications, not just how they affect the heart and arteries.

Pain relief that’s good for the heart

If you have heart disease and often take a pain reliever or anti-inflammatory agent, this study and others suggest that naproxen doesn’t harm the heart. The same holds for acetaminophen. It isn’t an NSAID, and so is easier on the stomach. But acetaminophen has its own hazards, primarily liver damage if taken in large amounts or with alcohol.

Keep in mind that what we’re talking about here is routine use of pain relievers. Don’t hesitate to take one for a headache or other occasional aches and pains. But if you need one several times a week, or every day, choosing the right painkiller could make a difference for your heart.

How do you choose what pain reliever to take?

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