NSAIDs and Heart Risk: What You Need to Know

Understand how NSAIDs can increase your risk of heart attack and stroke—even with short-term or moderate use.

By Sneha Tete, Integrated MA, Certified Relationship Coach

Created on Sep 25, 2025

Understand how NSAIDs can increase your risk of heart attack and stroke—even with short-term or moderate use.

NSAIDs and Heart Conditions: Understanding the Risks

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely used medications for relieving pain and reducing inflammation. While effective, mounting evidence shows that NSAIDs can significantly increase the risk of serious heart disorders, such as heart attack and stroke—particularly with high-dosage or prolonged use.

What Are NSAIDs?

NSAIDs, or nonsteroidal anti-inflammatory drugs, include both prescription and over-the-counter medications used to reduce pain, inflammation, and fever. Common examples are:

Ibuprofen (Advil, Motrin)
Naproxen (Aleve, Naprosyn)
Diclofenac (Voltaren)
Indomethacin (Indocin)
Celecoxib (Celebrex) – a selective COX-2 inhibitor

People use these drugs to manage symptoms of conditions such as arthritis, headaches, muscle pain, and other chronic inflammatory illnesses. They are available in tablet, topical, and sometimes injectable forms.

How Do NSAIDs Increase Heart Risk?

Years of research establish a clear link between NSAID use and an increased risk of cardiovascular events like heart attack (myocardial infarction), stroke, heart failure, and death from heart conditions .

Key mechanisms for increased cardiovascular risk include:

Narrowing of blood vessels and altered blood flow to the kidneys, causing the body to retain fluids and salts, which can elevate blood pressure.
Increased blood pressure and fluid retention, raising the workload and stress on the heart.
Elevated tendency for blood clots by increasing certain clot-forming chemicals (prostaglandins), making heart attack and stroke more likely.

Some NSAIDs, like selective COX-2 inhibitors (e.g., celecoxib), were initially developed to minimize stomach lining damage but still pose cardiovascular risks. In 2004, the popular COX-2 inhibitor Vioxx (rofecoxib) was withdrawn from the market due to increased reports of heart attacks and strokes.

Who Is Most at Risk?

The risk of developing heart problems from NSAIDs varies based on personal health, type of medication, dosage, and duration:

People over age 65 or with existing heart conditions have a higher risk
Individuals with high blood pressure, high cholesterol, or diabetes face increased risk
Smokers and those with a family history of cardiovascular disease are also more vulnerable
The risk is lowest for healthy adults who take NSAIDs occasionally and at the lowest effective dose
Frequent, prolonged, or high-dosage NSAID use significantly raises the risk of heart attack or stroke for everyone

According to the FDA, even short-term use can increase these risks, and people treated with NSAIDs after a heart attack are more likely to die within the following year.

How Soon Does Risk Begin?

Recent research and FDA communications emphasize:

Cardiovascular risk can increase within a few weeks of starting an NSAID
Longer NSAID use and higher doses increase the danger
The risk is significant for both people with and without prior heart disease, although it is greatest for those with existing cardiovascular conditions

How NSAIDs Work – and Why This Matters

NSAIDs function by blocking the production of prostaglandins — hormone-like substances that play a role in pain, inflammation, clot formation, and protection of the stomach lining.

Type of NSAID	Function	Cardiovascular Risk
Traditional (ibuprofen, naproxen, diclofenac)	Block both COX-1 and COX-2 enzymes	Elevated risk, especially at higher doses or longer use
Selective COX-2 inhibitors (celecoxib)	Block only COX-2 enzyme (responsible for pain/inflammation)	Less stomach damage, but still increased heart risk

By altering prostaglandin production, these drugs can raise blood pressure and promote clot development, making cardiovascular events more likely—especially in those already at risk.

What the FDA and Studies Say

Given the strong evidence linking NSAIDs to heart attack and stroke, the FDA requires prominent warning labels on all NSAIDs (excluding aspirin), noting:

Risk may emerge within a few weeks of starting treatment
Greater danger at higher doses or with prolonged use
Risk is increased whether or not you have existing heart disease
No consensus on which specific NSAID is safest, though some data suggest naproxen may pose slightly less risk than other options, but evidence remains inconclusive

Because of these risks, NSAIDs—other than aspirin—are not recommended for people with established heart disease unless the benefits clearly outweigh the risks.

Warning History

2005: The FDA first required heart attack and stroke warnings on NSAIDs.
2015: Warnings strengthened, highlighting quick onset (within weeks), increased risk even without prior heart disease, and higher death rates among those treated with NSAIDs after a heart attack.

Comparing Different NSAIDs: Is Any One Safer?

Extensive studies have attempted to pinpoint if some NSAIDs might be safer for the heart:

Ibuprofen may have slightly less cardiovascular risk than other non-selective NSAIDs, such as diclofenac, but robust conclusions are lacking
Naproxen was historically considered to have a lower risk for heart attack and stroke, but evidence on this remains mixed
Selective COX-2 inhibitors (e.g., celecoxib) were widely used because they are gentler on the digestive system but can still increase cardiovascular risks

Ultimately, most health authorities recommend the lowest effective dose for the shortest possible duration, and suggest discussing risk factors with your doctor before starting any NSAID—especially if you have a history of heart or vascular disease.

Symptoms of Heart Attack and Stroke

If you use NSAIDs—especially for long-term pain relief—be vigilant for symptoms of heart attack or stroke:

Sudden chest pain or discomfort
Shortness of breath
Pain radiating to the jaw, neck, or arm
Sudden weakness or numbness (especially on one side of the body)
Slurred speech, confusion, or trouble understanding
Sudden, severe headache

Seek emergency help if you notice any of these signs.

Managing Pain While Minimizing Heart Risk

If you need to take NSAIDs, reduce your risk by:

Taking the smallest effective dose for the shortest duration necessary
Avoiding chronic or high-dose use without medical guidance
Discussing heart history, risk factors, and alternatives with your healthcare provider
Being cautious if you are over 65 or have heart disease, hypertension, high cholesterol, or diabetes
Monitoring for symptoms of heart attack or stroke

For people with heart risk, alternative pain relievers (such as acetaminophen) may be safer for long-term use

Other Considerations and Drug Interactions

NSAIDs can interfere with heart-protective drugs such as aspirin or blood thinners. Always check with your doctor before combining medications.
If you have had a recent heart attack, talk to your doctor before taking any NSAID.
Other factors, such as underlying kidney disease or liver problems, may further increase risk.

Frequently Asked Questions (FAQs)

Q: Can I take NSAIDs for a cold or headache if I have heart issues?

A: Occasional, short-term NSAID use for minor ailments is typically low risk for most people. However, if you have known heart conditions or other cardiovascular risk factors, consult your doctor before taking NSAIDs—even briefly.

Q: What is the safest NSAID if I am worried about my heart?

A: Data suggest naproxen may have a slightly lower risk for heart issues than other NSAIDs, but no NSAID is entirely free of risk. The safest approach is to use the lowest effective dose for the shortest time, and speak with your doctor about individual risk factors.

Q: Are over-the-counter NSAIDs safer than prescription ones?

A: The risks are similar for both OTC and prescription NSAIDs at equivalent doses. Always follow instructions and avoid exceeding recommended doses.

Q: What if I need NSAIDs long-term for chronic pain?

A: Chronic, high-dose NSAID use is more likely to cause heart complications. Review your regimen regularly with your healthcare provider and explore alternatives where possible.

Q: Does aspirin carry the same heart risks?

A: Unlike most NSAIDs, low-dose aspirin is commonly used as a heart protector. Other NSAIDs do not share aspirin’s protective effect and may actually counteract it if taken together. Always discuss with your doctor before combining these drugs.

Key Takeaways

NSAIDs are widely used for pain, but even short-term or moderate-dose use can raise your risk of heart attack and stroke.
People with heart disease, risk factors, or older age are most vulnerable.
Use the lowest dose for the shortest time and review pain relief options with your doctor if you have any cardiovascular risk.
If you experience any symptoms of heart attack or stroke, seek immediate medical help.

References

Author

Sneha TeteBeauty & Lifestyle Writer

Sneha is a relationships and lifestyle writer with a strong foundation in applied linguistics and certified training in relationship coaching. She brings over five years of writing experience to thebridalbox, crafting thoughtful, research-driven content that empowers readers to build healthier relationships, boost emotional well-being, and embrace holistic living.

Read full bio of Sneha Tete