Question: Should I take a nonsteroidal anti-inflammatory drug (NSAID) if I have had a heart attack?

Dr. Brownstein's Answer:

Researchers recently investigated whether nonsteroidal anti-inflammatory drugs (NSAIDs) altered the decline in cardiovascular risk after a heart attack, and published their findings on the website of the journal Circulation on September 10, 2012. Of the 99,187 patients who had suffered a heart attack, 43,608 (or 44 percent) were prescribed an NSAID after the heart attack.

During a five-year follow-up period, the researchers found that the use of any NSAID in the years following a heart attack was associated with an increased risk of death. There was a 59 percent increased risk of death in the first year after a heart attack and a 63 percent increased risk of death after five years when patients took an NSAID.

The authors concluded, “The use of NSAIDs is associated with persistently increased coronary risk regardless of time elapsed. We advise long-term caution in using NSAIDs for patients after [a heart attack].”

Inflammation is the body’s response to a stressor. Infection, injury, nutrient depletion, stress, and hormonal imbalances can all lead to an inflammatory state. Inflammation is actually good for the body; it is a signal to the immune system that something is wrong and needs to be repaired.

Long-term use of NSAIDs is associated with a host of adverse effects including gastrointestinal bleeding. Of all the NSAIDs studied in this report, naproxen had the lowest cardiovascular risk. This is just one of many studies that demonstrate a link between NSAIDs and increased cardiovascular risks.

I rarely prescribe anti-inflammatory medications. If they are used, they should be used for only a short time period — less than two weeks.