NSAIDs and Heart Failure: What’s the Connection?

Nonsteroidal anti-inflammatory drugs (NSAIDs) are popular and highly effective pain relievers, but despite their widespread use, they do pose risks.

NSAIDs are known for multiple adverse effects, including gastrointestinal bleeding, cardiovascular side effects, and NSAID-induced nephrotoxicity (rapid deterioration of the kidneys). Most notably, these common pain relievers can raise your risk of heart failure, particularly if you have had a heart attack in the past.

This article will highlight the role of NSAIDs in heart failure and shed light on the specific NSAIDs that may put you at higher risk of a heart-related medical complication.

Woman taking pain meds

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What Are NSAIDs?

Nonsteroidal anti-inflammatory drugs (NSAIDs) are medications that are commonly used to reduce aches and pain and bring down a fever. These drugs, which are available over the counter and by prescription, work by reducing levels of the pro-inflammatory chemical prostaglandin.

NSAIDs are used to treat a wide range of conditions that cause inflammation, mild to moderate pain, and fever, including:

Anti-Inflammatory Drugs List

NSAIDs are one of the most versatile, inexpensive, and widely used drugs in the world. Some commonly used NSAIDs include:

Some drug companies have even combined NSAIDs with other anti-inflammatory medications to treat pain associated with specific conditions. For example, the medication Excedrin combines acetaminophen, aspirin, and caffeine to treat migraine pain. 

How NSAIDs Work

Prostaglandins are hormone-like chemicals in the body that contribute to inflammation, pain, and fever by raising body temperature and dilating blood vessels. This causes redness and swelling in the place they are released.

Prostaglandins have a bad reputation because they make us feel lousy when we are sick. In truth, they are essential to our health as they protect the lining of the stomach and intestines from the damaging effects of acid, promote blood clotting by activating blood platelets, and make it possible for the kidneys to function optimally.  

When the body is in distress, it enters a pro-inflammatory state in its quest to fix the issue. This can cause us to experience pain and fever, prompting us to take NSAIDs.

NSAIDs work by blocking the enzyme cyclooxygenase (or COX), which is used by the body to make prostaglandins. The two types of COX enzymes are:

  • COX-1 is present in most tissues all the time.
  • COX-2 is mainly expressed in response to inflammation.

Both COX-1 and COX-2 produce prostaglandins that cause pain and inflammation, but COX-1 produces the group of prostaglandins that protect the lining of the stomach from acid and is an essential component of the blood-clotting process.

Traditional NSAIDs, like Motrin (ibuprofen), aspirin, and Aleve (naproxen), block both COX-1 and COX-2. These should be taken with caution as they can cause ulcers and increase your risk of gastrointestinal bleeding. This is especially true when the inhibition of COX-1 results in a severe reduction of prostaglandin synthesis throughout the body. 

What Is the Link Between NSAIDs and Heart Failure?

If you have a history of cardiovascular disease or a weakened left side of your heart called left ventricular dysfunction, taking NSAIDs may worsen your heart failure.

This is because NSAIDs impair renal function (the working ability of your kidneys) by inhibiting the production of prostaglandin. As a result, water and sodium are retained and blood flow to the kidneys is reduced (marked by a lower glomerular filtration rate).

NSAIDs worsen kidney function, which throws off the homeostasis (balance) of the cardiovascular system. Retained fluid can overwhelm the weakened heart, a phenomenon called cardiac decompensation. Cardiac decompensation compromises the heart's ability to pump blood while also worsening kidney function due to poor blood flow.

Which NSAIDs Increase the Risk of Heart Failure?

Not all NSAIDs are problematic for the heart. For instance, aspirin is sometimes used as a blood thinner and may have a protective effect on the heart. The NSAIDs that pose the biggest risk include:

Ibuprofen: Research has found that ibuprofen, such as Advil and Motrin, can worsen existing high blood pressure (hypertension) or lead to the development of high blood pressure. These drugs also are linked to kidney damage (nephrotoxicity), worsening of heart failure, and even heart attack or stroke.

COX-2 inhibitors: When more COX-2 is blocked relative to COX-1, it can increase the risk of blood clots forming (thrombosis). This, in turn, raises the risk of adverse cardiovascular thrombotic events. Among the traditional NSAIDs, Voltaren (diclofenac), Celebrex (celecoxib), and Mobic (meloxicam) are relatively COX-2 selective.

Does Dose Matter?

The general rule of thumb is to use NSAIDs at the lowest effective dose for the shortest time possible should you need the medication. If you have heart failure, only use NSAIDs under the guidance of your healthcare provider.

What About OTC Ibuprofen?

Always discuss OTC ibuprofen use with your healthcare provider if you have diabetes, hypertension, or a history of heart failure. OTC ibuprofen, when used regularly, can cause or worsen heart failure although most people are usually fine using ibuprofen as needed for pain relief.

Should I Use NSAIDs If I Already Have Heart Disease?

Current guidelines for heart failure therapy recommend avoiding NSAIDs because they can cause sodium retention and vasoconstriction (narrowing of blood vessels). The drugs can also reduce the effectiveness and increase the toxicity of ACE inhibitors and diuretics.

When to Seek Medical Attention

If you are taking NSAIDs and feel any new signs or symptoms such as fatigue, dizziness, headache, shortness of breath, or belly, chest, or back pain, you may be experiencing a medical complication from your NSAID use. You should seek immediate medical attention, even if you do not feel that your symptoms are life-threatening.

If you experience any of the following symptoms, whether you have been taking NSAIDs or not, you could be having a heart attack or stroke. Call an ambulance or have someone take you to the emergency room immediately if you experience:

  • New or worsening chest pain
  • Have chest discomfort that feels like someone is sitting on your chest
  • Sudden slurred speech
  • Weakness in one part or side of the body


Summary

By reducing the production of prostaglandins, NSAIDs help relieve the discomfort of fever and reduce the pain associated with inflammation. But if they are overused, they can cause or worsen heart failure, especially in those who are at high risk of cardiovascular disease, such as those with diabetes or hypertension, and people who have a prior history of heart failure. 

A Word From Verywell 

NSAIDs are one of the most used prescription and over-the-counter drugs in the world, but research shows that these drugs can elevate blood pressure, damage the lining of the stomach and kidneys, and worsen heart failure.

If you have high blood pressure, diabetes, or a weak heart, consult a healthcare professional before using this class of medication. For most people, short-term, occasional use is probably safe, but make sure to check your blood pressure regularly and try to get off them as soon as possible.

Frequently Asked Questions

  • How do NSAIDs trigger congestive heart failure?

    NSAIDs can impair kidney function, causing water and sodium to be retained. Retained fluid can overwhelm the heart, a phenomenon called cardiac decompensation. Cardiac decompensation compromises the heart's ability to pump blood, while also worsening kidney function due to poor blood flow creating a vicious cycle. 

  • Can you take NSAIDs with heart failure?

    Yes, but you should do so only under the guidance of a healthcare professional. Not all NSAIDs are bad for your heart. In fact, some studies have found that a baby aspirin (81 milligrams, about one-fourth of an adult dose) per day may help your heart, although those claims have come under fire as of late. 

    If you are in pain, some healthcare providers may suggest taking plain regular aspirin at the lowest dose possible and for the shortest amount of time, while others may suggest Tylenol (acetaminophen), which is in another drug class, for pain relief. 

  • What drugs should be avoided in heart failure?

    Ibuprofen, naproxen, and selective COX-2 inhibitors such as diclofenac, celecoxib, and meloxicam, should be avoided in those with heart failure.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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