Could Your Cold Medicine Give You a Heart Attack?
Achoo! Tempted to reach for some over-the-counter relief? Here's what you should know about the research on NSAIDs and heart attack risk.
When you’re laid up in bed—nose running, head throbbing—it’s tempting to grab a bottle of over-the-counter medication for relief. Before you do, consider this: Taking a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen or naproxen may increase your risk for having a heart attack or stroke. That’s according to the U.S. Food and Drug Administration (FDA), which beefed up its warning about the risks associated with NSAIDs in 2015 after an expert panel reviewed the research.
“NSAIDs are important for dealing with things like inflammation and platelets clumping,” says Michael Blaha, MD, director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease in Baltimore. “So when you take an NSAID you reduce the risk for inflammation, but you also increase the risk for blood clots.”
Those serious side effects can occur as early as the first few weeks of using an NSAID, and the risk might go up the longer you take them. The NSAIDs in question include ibuprofen (Motrin, Advil), naproxen (Aleve), diclofenac (Cambia, Voltaren), and celecoxib (Celebrex). The warning doesn’t apply to aspirin.
How do NSAIDs work?
When we’re sick or injured, the body works to heal itself by producing prostaglandins and other chemicals, says Dr. Blaha. These hormones promote blood flow to the affected area, so it might become red, sore, and inflamed. This inflammation helps blood to clot effectively and protects the stomach from acid damage. It also protects the endothelium, the protective inner layer of the coronary arteries.
While the inflammation allows our body to heal, it can also result in pain, fever, reddening, and swelling, says Dr. Blaha. NSAIDs block the production of prostaglandins, which then lowers inflammation, reduces fever, and relieves pain when we’re sick. “In reducing the prostaglandin inflammation you also tinker with the blood-clotting mechanism,” adds Dr. Blaha.
Why could NSAIDs increase the risk of a heart attack?
As NSAIDs work, they reduce the protection of the endothelium. The arteries can tighten up, making it harder for the heart to pump blood around the body, which increases the possibility of a heart attack.
Research, including a study published in 2017 in The Journal of Infectious Diseases, suggests that people who take NSAIDs for an acute chest infection (like a cold or the flu), were about three times more likely to suffer a heart attack than those who didn’t take the medication. The risk increased to about seven times more likely for those who received an NSAID intravenously while hospitalized.
The study included about 9,700 people with an average age of 72; about 61% were men. Many of the study subjects had other conditions, like type 2 diabetes or high blood pressure, and many were taking other medications as well.
“The FDA has acknowledged for quite some time that NSAIDs can increase your risk for cardiovascular disease,” says Dr. Blaha. “This study suggests that might extend to shorter exposures like acute infections” such as a cold or the flu.
Who is most at risk?
There are a number of factors that can increase your risk of having a heart attack after taking NSAIDs. If you’ve previously had a heart attack or have a history of coronary disease, it could be aggravated by the use of an NSAID. Someone who is fit and healthy, however, is less likely to be affected, says Dr. Blaha.
The Journal of Infectious Diseases study looked at people with respiratory infections. But taking NSAIDs for any reason—such as a headache or an ankle sprain—isn’t a good idea for anyone with an increased risk of heart problems, especially for a prolonged period. “It’s better to consider an alternative medication, such as acetaminophen or aspirin,” says Dr. Blaha. Aspirin is also an NSAID, but it doesn’t pose a risk of heart attack or stroke.
Discuss any medication, including over-the-counter ones, with your doctor or pharmacist, especially if you think you’re at risk.
Bottom line: “If you need to take an NSAID for a particular reason—for anti-fever or because of a headache or pain—it’s OK to take it,” says Dr. Blaha. “But be aware that it puts you at increased risk and you should take it at the lowest dose for shortest period of time possible.”
- Michael Blaha, MD, director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease in Baltimore
- The Journal of Infectious Diseases: "Acute Respiratory Infection and Use of Nonsteroidal Anti-Inflammatory Drugs on Risk of Acute Myocardial Infarction: A Nationwide Case-Crossover Study"
- U.S. Food and Drug Administration: "FDA Drug Safety Communication: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes"