Cardiovascular safety of non-steroidal anti-inflammatory drugs (NSAIDs)

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Cardiovascular safety of non-steroidal anti-inflammatory drugs (NSAIDs)

I’m surprised how many of my patients are NOT aware of the potential cardiovascular risks of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil) or naproxen (Aleve). If you’re in their camp, don’t miss this report:
Now a new study has combined all of the available studies to give us a deeper look at this topic. In this “meta-analysis,” all large scale randomized controlled trials comparing any NSAID with other NSAIDs or placebo.
The primary outcome was myocardial infarction. Secondary outcomes included stroke, death from cardiovascular disease, and death from any cause. 31 trials in 116 429 patients with more than 115 000 patient years of follow-up were included.
Patients were allocated to:

  • naproxen (Naprosyn, Aleve),
  • ibuprofen (Advil, Motrin),
  • diclofenac (Cataflam, Voltaren),
  • celecoxib (Celebrex),
  • along with several NSAIDS not available in the U.S. (etoricoxib, rofecoxib, lumiracoxib), or
  • placebo.

When it comes to heart attack (myocardial infarction, MI) risk,:

  • all of the products currently available in the U.S. seemed safe (when compared to placebo), however,
  • naproxen and diclofenac had the lowest risk.

However, when it comes to stroke (CVA) risk:

  • ibuprofen was associated with the highest risk of stroke followed by diclofenac and celecoxib.
  • naproxen had the lowest risk.

When it comes to “cardiovascular death” risk or the risk of “death from any cause”:

  • diclofenac was associated with the highest risk among the NSAIDS available in the U.S.
  • naproxen had the lowest risk.

The authors concluded, “Although uncertainty remains, little evidence exists to suggest that ANY of the investigated drugs are (completely) safe in cardiovascular terms. “
So, if you have any cardiovascular risk and are looking for an agent for fever, pain, or inflammation, what are you to do?
Acetaminophen (Tylenol) may be your safest choice. After that, the researchers say, “Naproxen seemed least harmful. “
The bottom line for us doctors? The researchers tell us, “Cardiovascular risk needs to be taken into account when prescribing any non-steroidal anti-inflammatory drug.”


  1. Hi Walt,
    I find this quite interesting. I found out by my eye dr. I had a half stroke in my eye. My vision was distorted. He referred me to a retina specialist and I get injections in my eye once a month for 5 months. Every dr. (even PCP) has said it was a fluke. I had just recently gone to the cardiologist and blood pressure ok and meds i am on fine. The PCP thought maybe it was low dose estrogen which i recently stopped. I am now thinking it might have been advil. I had more during the time of my shoulder surgery in August.

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