NSAIDs and their link to heart attack

[Toneman]

I'm concerned about he use of Celebrex which was prescribed to me by my Rhuematologist for arthritis is my knees and ribcage. I have read all the warnings about the possible link of NSAIDs and heart attack and would like your opinion. I was originally prescribed 200mg once a day and it was later changed to 100mg twice a day so I could take it at night as the pain in my knees and sternum tend to keep me awake. The Celebrex has made my knees feel much better but it seems to be less effective on the intercostal pain, but still does releive it to a certain degree.

About me, I am a 48 year old male with controlled hypertension with Benecar HCT 40/25. My blood pressure averages 115/75. My latest lipid profile from last month shows total cholesterol of 170, LDL 63 and HDL 40, tri's still high at 333 but have come down substantially with lifestyle and diet changes. I am 50lbs overweight but have lost 50lbs this year with these changes along with a regular exercise routine. I had an annual cardiac work up this past March with bloodwork, Echo and Nuclear stress test, all came back normal with absolutley no concerns.

My knees are now doing so much better since I started to take the Celebrex and is the main reason I have been able to get back into an agressive exercise routine again. I can get a nerve block or shots in the affected areas to relieve the intercostal pain, but the Celebrex is the only thing that has helped my knees. Given my profile, how concerned would you be with the use of an NSAID like Celebrex? Could it counteract the HP medication?

Thanks,

Jon

[CCF-M.D.-MJM]

Hi Jon,

Very good and important questions.

Any NSAID increases the risk of cardiovascular events with Vioxx being one of the biggest culprits (as pointed out by our very own Dr. Eric Topol in JAMA about 4 years before anyone paid attention to it).  There is a continuum of risk down to and including ibuprofen.  The risk is relatively low, but there is still risk.  Everyone needs to understand is that every medications has risk and benefits.  The theurapeutic window from some medications is great and even saves lives -- like statins for people with coronary artery disease.  Other medications like NSAIDs make important contributions to quality of life, but carry the risk of increased cardiovascular events like heart attacks and stroke.  There is no easy answer.  what I tell my patients is that they need to decide how much the medication improves their symptoms.  If it is not worth living without the benefit of decreased knee pain, there is probably worth the slight increased risk of cardiovascular events.  It is not an easy decision.

NSAIDs can increase blood pressure and some NSAIDS like ibuprofen (Advil) have been shown to decrease the beneficial effects of aspirin for cardiovascular disease.

Your overall risk of cardiovascular events with Celebrex is low, but it is probably higher than if you were not taking the medication.  Unfortunately this is not a yes or now questions.

I hope this answers your question.  Good luck and thanks for posting.

[anacyde]

I was kind of wondering what exactly it is about the NSAIDs that increase cardiovascular risk.  I knew about the general heart attack/stroke risks associated, but I've also heard that people with CHF should not take ibuprofen, so it made me wonder if there was more to it.  Apparently NSAIDs can increase CHF symptoms?

I think ibuprofen is an awesome drug when I get severe pain (read: so bad I can't do anything unless I take an Advil...happens two, maybe three times a year and is usually a headache) but I've suffered through whatever the pain was since hearing about the detrimental effects it can have - both on the cardiovascular system and on the GI system.  To me, not worth it.

[Toneman]

NSAIDS are what is known as a COX-2 inhibitors and the basic problem is that they will make you retain water thus increasing the volume of your blood and fluid load which results in increased blood pressure. If someone already has high blood pressure, a NSAID will just increase the problem plus it may counteract some high blood pressure medications that include diuretics. Also, if you have a vulnerable plaque in one of your arteries, the sudden increase in blood pressure could cause a rupture which would normally lead to an MI.

The most dangerous NSAID was Vioxx, which was a COX-1 inhibitor, which is still an NSAID, but had a much higher risk for heart issues which is why it was pulled from the market. The new COX-2 inhibitors don't have as high a risk, but it is still there.

Jon

[anacyde]

Thanks!  That also explains why it causes CHF symptoms to increase (fluid load).  One of the primary goals of CHF management is to reduce fluid load, since the heart is less capable of handling it with reduced function.  Great info!

[texas2step]

Been gone for awhile and noted this post.  I love Advil for great pain relief but I am thinkinbg this med now has worsened feet swelling. Docs always said feet swelling is cosmetic but I feel they are wrong. I see Eric Topols's name mentioned here.  I have read many articles that he has written on just about everything and this man is very informative and has taught me a lot.   He stands for what he beleives and I like that in a doctor.  I wish he were here in Texas.