The bad news about the dangers of NSAIDs (non-steroidal anti-inflammatory drugs) for the heart and the cardiovascular system continues to accumulate. We’re guessing that very few American health care providers noticed an article in the BMJ (formerly the British Medical Journal) that was published on July 4, 2011. Hey, it was a big holiday weekend!
The article was titled: “Non-steroidal anti-inflammatory drug use and risk of atrial fibrillation or flutter: population based case-control study.” Even though this research disappeared without a trace into the giant black hole, it is incredibly important for tens of millions of Americans (as well as people all over the world).
The research was carried out on 32,602 patients in Northern Denmark who were diagnosed with A-fib (atrial fibrillation) or flutter. These can be serious arrhythmias with devastating consequences. Because the upper chambers of the heart are not beating forcefully, blood clots can form in the left atrium and travel to the brain, leading to a stroke. That is why people who are diagnosed with A-fib are often prescribed blood thinners such as warfarin (Coumadin). Although this anticoagulant can reduce the risk of developing a blood clot and a stroke, it carries its own risks. Visit our drug library to read about the dangers of various drug and food interactions with warfarin.
The subjects in the Danish study were matched with 325,918 control patients to compare the use of pain relievers such as ibuprofen (Advil, Motrin, etc.), celecoxib (Celebrex), diclofenac (Cataflam, Voltaren), etodolac (Lodine), ketoprofen (Orudis), meloxicam (Mobic) and naproxen (Aleve, Anaprox, Naprosyn, etc). The investigators reported that, “In this large population based case-control study, we found that patients starting treatment with non-aspirin NSAIDs were at increased risk of atrial fibrillation or flutter compared with those not using NSAIDs. The relative risk increase was 40-70%–equivalent to approximately four extra cases per year of atrial fibrillation per 1,000 new users of non-selective NSAIDs and seven extra cases per year of atrial fibrillation per 1,000 new users of COX 2 inhibitors. The risk appeared highest in older people.” These investigators speculate that the irregular heart rhythms might be triggered through an adverse kidney effect.
Now, you might blow off the idea of 4 or even 7 cases of atrial fib per 1,000 users of NSAIDs, figuring that your risk is really low. That’s probably true if you are young and healthy. But the risk goes up if you have kidney problems or are older. And keep in mind that an estimated 20 million Americans swallow a nonprescription NSAID each day. Add in prescription NSAIDs like Celebrex, diclofenac, ibuprofen, naproxen or meloxicam (total annual prescriptions for such NSAIDs is more than 60 million) and you discover an astonishing public health worry. According to our calculations, that could equal over 200,000 cases of drug-induced atrial fibrillation annually.
This isn’t the first time NSAIDs have been linked to A-fib. A study of patients in the UK published last year also reported an association (roughly 44% increased risk) in patients taking such pain relievers (Arch. Intern. Med. 2010; 170:1450-1455).
We have been wondering why there seems to be such an epidemic of atrial fibrillation in the U.S. Over the last few decades we have heard of more and more middle-aged people being diagnosed with A-fib. We used to think of this as an older person’s problem. Now we are starting to consider the possibility that it could be brought on in part by our love affair with NSAIDs.
As if all this weren’t enough, we have increasing evidence that NSAIDs increase the risk of heart attacks.
So, what is someone with arthritis or bursitis or tendinitis or just about any other “itis” to do? Well, there is always aspirin. It is just as good as NSAIDs for relieving pain but instead of causing heart attacks, it reduces that risk. Of course, aspirin does increase the danger of serious stomach irritation or even a bleeding or perforated ulcer. That is not a trivial risk.
We are leaning more and more towards natural approaches for pain and inflammation. Should you be interested, we have a new book just out from National Geographic (The People’s Pharmacy Quick & Handy Home Remedies) that offers lots of non-drug options for arthritis and other inflammatory problems. There are some of our classic home remedies (gin-soaked golden raisins and Certo and grape juice) plus great information about anti-inflammatory products like turmeric, pomegranates, ginger, boswellia, cherries, honey and vinegar, pineapple juice, vitamin D and fish oil.
Now that we know NSAIDs pose such a significant cardiovascular and heart risk, perhaps it is time for the FDA to reconsider promiscuous use of these drugs and warn people about some of these newly discovered dangers.

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  1. Mary L
    Reply

    My pulse slowed to 55-60 beats per minute (resting), with up to 12 long pauses, time for a ‘missed’ beat, since I was prescribed 70mg per day aspirin 5 months ago. I stopped taking aspirin a few days ago and my pulse is almost back to normal, with not more than 1 missed beat per minute and up to 70 beats per minute (resting). I think I will do without aspirin in future.

  2. s a wilson
    Reply

    What concerns me about this study which will surely worry many of us who depend on controlling the pain of chronic illnesses such as osteoarthritis is that the article does not state whether the rather small increases in risk were statistically significant using the basic scientific rule of thumb p

  3. E MORRISON
    Reply

    I was finally diagnosed after having an MRI scan on whole of back and it was decided that pain was so severe that I would be put on naproxen 500mgs twice a day with co-codamol smaller dose for day time and if required large dose for bed time, after being on this for 6 weeks approx I have been suffering from a.f. just feel that I am not getting enough o2 at times not a nice feeling.
    I was given diclofenic last year for almost the same time that I have been on naproxen I suffered strange pain in top of head and had the common sense to contact pharmacy who said to stop taking them as there is concern with the usage of diclofenic? g.p sent me for echo-cardiogram/and carotid scan both negative but cardiologist found heart murmur for the 3 months that I was not taking nsaid I was fine now I have pain almost every day in top of head.
    I can tell you if I didn’t require this drug for the severe nerve pain in back I would stop it tonight.
    also has anyone found a problem with muscles in eye while taking this drug?

  4. KKR
    Reply

    In the beginning of April 2013 I had periodontal surgery (crown lengthening) and was given an RX for 600mg Ibuprofen for initial swelling and pain. I took as directed but the pain got very bad. Checked out ok and told pain should ease up and to add benzocaine topical to area. Took ibuprofen 400-600 mg and coated gum with benzocaine frequently–my fault, more frequently than I should. Didn’t think I’d have a problem as I had never had a reaction to ibuprofen and/or benzocaine. One day a few weeks later (still taking the ibuprofen and benzocaine) after being in the yard (hot and humid), I experienced an unusual flip-flop in my chest.
    After 4 hours I went to the ER and was diagnosed with AFIB. I mentioned the ibuprofen use and questioned if this could have caused it. ER Doctor, Cardiologist both said “no”, “never heard of that”. Well, I am still convinced that this was a cause. Now I have paroxysmal afib and on an anticoagulant daily as well as medication for when I have an episode.
    Now, unfortunately, I have arthritis pain and have nothing to take except acetaminophen–and we know about that drug……
    Karen

  5. JMC
    Reply

    I will be 61 tomorrow and have been living with diabetes for about 15 years (2-3 untreated/undiagnosed) as well as hepatitis-C since the mid-80’s. A recent liver biopsy revealed only minimal damage which I and my gastroenterologist found to be pretty phenomenal. I work as a self-employed professional and hold a part-time job which is extremely physical.
    Last weekend, I attended all hours of a 3-day music festival. So, overall, I considered myself to be in fairly good shape. Today, I had a regular check-up with my physician & she discovered I now have a heart murmur. It later occurred to me that I forgot to mention that I take ibuprofen on an almost daily basis for joint pain. Since I have never been told I have a heart murmur, I can only conclude my long-term use of ibuprofen may have contributed to this condition.

  6. Anne
    Reply

    I was put on naproxen twice a day for tension headaches. I started getting PVC’s & fluttering after 3 weeks which I have all day everyday. I’m only 32 & discontinued that medication when the heart thing started about a month ago. I was very healthy & no prior health problems. Is their a way to stop the heart problem from continuing? Does it go away on it’s own?

  7. sd
    Reply

    I was diagnosed with afib by wearing a monitor three months ago. I take Toprol xl 25 generic twice daily and I also take Coumadin. I had taken goody powders for years until my stomach would not take them anymore. I started taken tylenol otc but the most I have ever taken is 4 a day. Someone told me that Tylenol could cause heart flutter. Is that the same as the afib?

  8. WRA
    Reply

    I can confirm that NSAID’s cause my A-fib. I had bouts with A-fib for several years that got progressively worse. My cardiologist carried out a cardioversion about three years ago and the A-Fib completely went away. But about 6 months ago I strained my back working at my parents house. My mom gave me a COX2 drug and I also took some ibuprofen that night. My A-fib came back the next day and lasted for a couple of days. I suspected a causal relationship and asked my doctor but he didn’t think it was necessarily connected.
    Then last week I tore my Achilles tendon while traveling overseas. They gave me some diclofenac rub to help with the pain and it really seemed to work. I didn’t realize that diclofenac is also a COX2 drug. After using it a couple of days, my A-fib came back again and is now very persistent. After a week, I still have it and now have to go back to the cardiologist. I’m guessing another cardioversion may be in order.
    I would like to thank the drug makers for all of the extra money I’m going to have to spend to get my heart back in rhythm. And who knows how many years these drugs have taken off of my life. I would think they would do a better job of warning their customers about this very serious side effect, especially those with a history of A-fib.

  9. Michelle J.
    Reply

    I’ve been taking high-doses of ibuprofen for over 2 years now and in the last few months I’ve had very uncomfortable heart palpitations. I’m going to print out this article and take it with me to my doctor’s visit this week.

  10. jrc
    Reply

    I just had AF diagnosed during screening for a vitrectomy and was incredibly surprised because I am very low on risk factors other than maybe age (I’m 63). I was suspicious in that my previous PCP used regular ECGs as part of her physicals and there had never been an indication in the past. I’m a non-smoking vegetarian with normal range BP; excellent LDL and HDL numbers; no other serious medical conditions and am only slightly overweight.
    I have, however recently been taking meloxicam on a daily basis to help with a tendon inflammation in my foot. The doctor had also put me on a course of Medrol and later a steroid injection when I resumed the meloxicam. I will certainly discuss this with the cardiologist when I see him this week.
    Thank you for the informative article.

  11. LH
    Reply

    Ian, I had atrial fibrillation for many years and coumadin was what was prescribed for me – I hated every moment of use. Then I came across an article about nattokinase and started taking it with the coumadin and then dropped the coumadin about seven years ago – my atrial fibrillation is gone, the clots I had in my left leg disappeared and I am a happy camper.
    Just for the record, I am 89 years old, have CHF and was given 5 months to live without heart surgery and 4 years with surgery. I declined surgery, went for chelation therapy and am here to disprove the theory that surgery is always the answer – read up on nattokinase – it might help you too. Good luck.

  12. Ian
    Reply

    Ironic that you should mention Boswellia. This herb, also known as Frankinsense, can cause immediate and severe episodes of Atrial Fibrillation (irregular and rapid heart beat). I know that from experience because I tried it.
    I am looking for a healthy alternative to Metoprolol which am taking for my AF. If anyone out there knows of one, let me know.

  13. lem
    Reply

    what is boswellia? How is it taken?

  14. jq
    Reply

    You mentioned boswellia . . I can attest to it working. I had terrible hip/joint pain which made it difficult to do stairs, sleep, even walk sometimes. I started on boswellia serrata and within two weeks I was VASTLY improved. I can now sleep – and lay on my hips to do so, have much more movement and even stairs do not make me hurt. It was a miracle for me.

  15. PP
    Reply

    In the late ’90’s I took some Aleve; one or two only and found I didn’t tolerate them well, so have never taken them again. A few months later I started having A-fib attacks that got progressively worse. Finally in 2003 had an electro-physical ablation that ended the problem. I wonder if that occasional use is what triggered the A-fib?
    PEOPLE’S PHARMACY RESPONSE: THAT WOULD BE VERY DIFFICULT TO DETERMINE.

  16. ck
    Reply

    I am not surprised but happy to confirm that my decision to stop taking Meloxicam -after 4 or 5 years of taking one daily pill -was the right one. In addition to reducing the side effects mentioned in the article my heartburn is gone and I feel so much better!

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