People with osteoarthritis (OA) are caught in a classic double bind. Their joints hurt! It is hard to function when knees, hips, shoulders, elbows or fingers ache. But the very arthritis pain relievers (NSAIDs or nonsteroidal anti-inflammatory drugs) that most people rely upon to give them relief are linked to heart attacks, congestive heart failure and strokes. The link just got stronger thanks to a comprehensive Canadian study (Arthritis & Rheumatology, online, Aug. 6, 2019). Ouch!
How Many People Suffer from Osteoarthritis?
The CDC reports that half the people over the age of 65 have “reported doctor-diagnosed arthritis” (CDC & Arthritis-Related Statistics). Consider that the next time you are in line at the supermarket or bank. Quite possibly the person in front of you or behind you is suffering.
Osteoarthritis makes it hard to get out of bed, climb stairs, open jars, hike or get down on the floor to play with grandchildren. Even younger people can experience osteoarthritis. The CDC reports that almost one third of those between 45 and 64 have doctor-diagnosed arthritis.
NSAIDs are the #1 Choice for Osteoarthritis:
NSAID-type arthritis pain relievers are the most common treatment for joint pain. Canadian and Japanese research suggests that three-quarters of patients with osteoarthritis take NSAIDs (British Columbia Arthritis Survey; BMC Medicine, April 14, 2011). We suspect that people in the U.S. use arthritis pain relievers at least as often as people in Canada or Japan.
Arthritis Pain Relievers and Heart Problems:
Nonsteroidal anti-inflammatory drugs or NSAIDs are increasingly linked to cardiovascular disease. Over a decade ago researchers discovered that rofecoxib, also known as Vioxx, increased the risk for heart attacks and strokes. One FDA safety officer was quoted (Forbes, Aug. 15, 2005):
“Graham has estimated that Vioxx killed some 60,000 patients—as many people, he points out, as died in the Vietnam War. He says fundamental problems at the FDA led to those deaths.”
Since then, clinicians have been trying to determine whether other NSAIDs like ibuprofen, diclofenac, meloxicam or naproxen could also be hard on the vascular system. The most recent epidemiological study was conducted in Canada (Arthritis & Rheumatology, online, Aug. 6, 2019).
People with arthritis are at greater risk for cardiovascular disease than healthy individuals. Until this study, one of the unresolved questions doctors faced was this:
is there something about OA that increases the risk of cardiovascular disease
is it the drugs used to treat osteoarthritis that cause the problems?
The Canadians did their best to resolve that uncertainty.
Arthritis Pain Relievers and Heart Problems: The Chickens or the Eggs?
More than 7,000 patients with osteoarthritis and three times that many nonarthritic control subjects were tracked for about a decade. In this study, with approximately 300,000 person-years of follow-up, more than 9,000 participants developed cardiovascular complications. Those with arthritis were about 31 percent more likely to have this outcome than people without arthritis.
Patients with osteoarthritis were much more likely to be taking an NSAID pain reliever. Upon analysis, the investigators found that NSAID use accounted for more than 40 percent of the increased risk of heart problems among Canadians with arthritis. Those taking such arthritis pain relievers were at greater risk for heart attacks, congestive heart failure and strokes.
Not the first time Arthritis Pain Relievers were Linked to Heart Problems:
The data from Canada are in line with other research suggesting that nonsteroidal anti-inflammatory drugs increase cardiovascular risk by 30 to 40 percent (BMJ, Jan. 11, 2011; BMJ, June 3, 2006). So, this new analysis is very much in line with older meta-analyses. The authors conclude:
“In conclusion, our study is the first to evaluate the mediating role of NSAID use in the association between OA and CVD [cardiovascular disease] based on population-based HAD [health administrative data]. Our findings suggest that a noteworthy portion of the increased risk of CVD among people with OA is mediated through their NSAIDs use.”
In plain English that means that a lot of people with arthritis are developing congestive heart failure, heart attacks and strokes because they are taking NSAID-type arthritis pain relievers. Some of these drugs (ibuprofen and naproxen) are available over the counter without medical supervision. In our opinion, the FDA has not provided adequate warnings on OTC labels.
What’s an Arthritis Patient to Do?
People with OA are definitely caught between the proverbial rock and a hard place. Without pain relief they cannot function well. But the most common treatment could lead to dire consequences. You can read more about this dilemma and how to reduce the risks at these links:
You may find the following article even more helpful. There are many NSAID-lovers who share their need for pain relief without risking a heart attack or a stroke. You will find a link to our eGuide: Alternatives for Arthritis!
Share your own challenges with osteoarthritis in the comment section. What has worked for you? Do you worry about the link between arthritis pain relievers and heart failure, heart attacks or strokes? If not, why not?