Link Between Ibuprofen, Heart Attack and Stroke Risk

I had a discussion last week with one of my patients regarding the link between taking ibuprofen,  heart attack and stroke risk. Following this discussion, I decided to write this post to explain some additional points regarding this association.

Ibuprofen (Advil) belongs to group of medications called non-steroidal anti-inflammatory (NSAIDs) drugs.

You might be familiar with other members of this group such as naproxen (Aleve), aspirin, indomethacin and a few other commonly used drugs.

These drugs have been used for decades to manage pain and reduce inflammation.

The most common indications for this type of medications are joint and back pain and headaches.

I’m sure that you’re all familiar with at least one of these drugs. Like every other medication, there are side effects related to these drugs that you should know.

Side effects

There are well-known side effects related to ibuprofen and other NSAIDs. They include high blood pressure, stomach upset, stomach ulcers, fluid retention and an increased rate of bleeding, especially stomach bleeding.

However, lately another major side effect has drawn the attention of researchers and practicing physicians. This side effect is related to the link between taking NSAIDs and an increased risk of heart attack and stroke.

Here let’s look at a recent major study examining this link.

Ibuprofen, heart attack and stroke risk

In 2005, the FDA warned consumers about the link between taking ibuprofen and increased heart attack and stroke. Later in 2015, the FDA repeated and intensified the same warning.

Recent analysis published in a British medical journal in 2017 concluded that naproxen was associated with an increased heart attack risk. The authors of the study suggested that the risk rises in the first week of the treatment with a high dosage of the medication.

Is it safe to take ibuprofen or naproxen?

I know what you’re thinking now. You’re probably asking yourself whether it’s safe to take ibuprofen, naproxen or any type of NSAIDs. These medications are available over-the-counter in the United States.

Many of you can access these medications without consulting with any physician. My suggestion is to talk to your doctor, if you’ve to take any of these medications on a regular basis.

It’s important to make sure that you don’t have kidney disease, risk for bleeding, risk of having a stomach ulcer or gastritis, your blood pressure is well-controlled and there are no signs of heart failure before recommending any NSAIDs including ibuprofen and naproxen.

The following suggestions might help in reducing the side effects and complications related to taking NSAIDs:

• Always make sure to talk to your physician, if you’ve to take any of the above medications for an extended period of time.
• Take the lowest dosage necessary to help with your symptoms.
• Make sure to take the NSAIDs with food.
• Try to take acetaminophen first, before trying NSAIDs. You should also make sure to limit the daily amount of acetaminophen to not more than 6 tablets (assuming that your liver function is intact).
• You should make sure to monitor your symptoms closely and call your doctor if you notice any chest pain, bleeding, fluid retention or stomach pain.

What should be the maximum dosage of ibuprofen or naproxen?

Try to keep the amount of ibuprofen less than 1200 mg and naproxen less than 750 mg daily.

Ibuprofen and naproxen can cause headaches

I’m not playing with words here. Regular intake of a NSAID can literally cause headaches. This condition is called analgesic (pain medication) induced headache. Your headache might sometimes continue, despite taking several of these medications.

The best therapy for this situation is to stop the NSAID itself.

At the end of this post, I’ve to remind you that medications aren’t too different than most things in our life, the medications have side effects and you can limit the severity of these adverse effects by using them wisely.