NSAID's

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Renal and cardiac risks.

Because they’ve been told over and over to take low doses of aspirin — an NSAID — to protect their hearts, most people are surprised to hear that NSAIDs pose cardiac risks. It’s true that low doses of aspirin make platelets less sticky and reduce the risk of clot formation. But other NSAIDs have slightly different mechanisms and can increase the risk of heart attack, stroke, and hypertension.

A study in the journal Lancet found that people who take high daily doses of NSAIDs increase their cardiovascular risk by a third; the exception was naproxen, which is kinder on the heart but harder on the gut. Another study in the journal Circulation found that for people who had had one heart attack, taking NSAIDs increased their risk of death by nearly 60 percent and of a second heart attack by 30 percent. The study found that naproxen, again, has the lowest cardiovascular risk among the NSAIDs.

The danger is especially great for people over 50 who have a history of heart or kidney problems or hypertension, says Rodolfo Curiel, MD, a rheumatologist and associate professor of medicine at the George Washington School of Medicine and Health Sciences. These people are often taking a number of medications, increasing the risk of bad drug interactions.

“It’s complicated, and sometimes the physicians don’t even understand it very well,” Curiel says. “NSAIDs are widely prescribed by primary-care doctors, but if they are not given to the right person, they can be poisonous. We see lots of problems from this.”

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