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Interventional Cardiology (Expert Forum)
NSAID's and heart disease
Answered by
Darcy Green Conaway, MD - General Cardiology, Echocardiology
Truman Medical Center
Questions in the Interventional Cardiology forum are answered by medical professionals affiliated with the Truman Medical Center. Topics covered include acute coronary syndrome, angina , atrial fibrillation , cardiac catheterization , cardiomyopathy , drug abuse & cardiac disease, echocardiography , heart failure , hypertension & heart disease , lipid management , minorities and heart disease, peripheral vascular disease prevention, valvular heart disease , women’s heart health, and the warning signs of a heart attack.
NSAID's and heart disease
by notdoneyet, Nov 16, 2007 10:48AM
I have heart disease and ankylosing spondylitis . Given the warnings about use of either Remicade/Enbrel and NSAID's for heart patients, I want to know what are the comparative risks and how should I assess whether I take ibuprofen (200mg or 400 mg) or naproxen (200 mg) to reduce inflamation (inflammation)(pain) as this seems to be the only thing that helps me be pain free enough to exercise or do my daily chores or choose Remicade or Enbrel which have been suggested but also have a risk for certain heart diseases (among other things?)
I am 61 yr old male , 11 years post triple bypass with grade 2-3 left ventrical dysfunction ( EF31-33%)Stage 2 heart failure( some breathlessness on exertion but no swelling, very little angina, (1-2km walking level suface without symptoms) Thanks for your help
Dan
I am 61 yr old male , 11 years post triple bypass with grade 2-3 left ventrical dysfunction ( EF31-33%)Stage 2 heart failure( some breathlessness on exertion but no swelling, very little angina, (1-2km walking level suface without symptoms) Thanks for your help
Dan
Doctor's Answer
by Darcy Green Conaway, MD, Nov 19, 2007 10:15PM
, Nov 19, 2007 10:15PM
The American Heart Association does not have FIRM recommendations regarding the use of NSAIDS, but there are recommendations for people with known coronary disease or people at risk:
It is known that certain NSAIDs increase risk of cardiac events (COX-2 inhibitors); there is also good evidence that it occurs with all NSAIDS. Having said that, the current recommendations are to start off with Naproxen since it has not been shown to do this and is considered "neutral" in risk; it doesn't mean that it might not get shown to have the same problem in a future study...
Most physicians are starting with Naproxen or using it after tylenol or tramadol fails.
Thanks for the interesting question.
It is known that certain NSAIDs increase risk of cardiac events (COX-2 inhibitors); there is also good evidence that it occurs with all NSAIDS. Having said that, the current recommendations are to start off with Naproxen since it has not been shown to do this and is considered "neutral" in risk; it doesn't mean that it might not get shown to have the same problem in a future study...
Most physicians are starting with Naproxen or using it after tylenol or tramadol fails.
Thanks for the interesting question.
