NSAID's and heart disease

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

[Darcy Green Conaway, MD]

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.