Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used class of medications to treat the pain and stiffness associated with spondylitis. Sometimes, higher doses of NSAIDs are needed to maintain relief from spondylitis symptoms. This can pose a problem because long-term NSAID use can cause significant side effects, especially in the gastrointestinal tract. A different class of NSAIDs, known as Cox-2 inhibitors (or Coxibs), allegedly reduce the risk of gastrointestinal complications associated with traditional NSAID therapy.
But now, research is showing that prescription-strength NSAIDs also carry significant risks of cardiovascular events. In a study published in the British Medical Journal in 2011, researchers found that NSAIDs significantly increase the risk of cardiovascular events in people who take these medications on a regular basis. In fact, long-term users of prescription NSAIDs have a two-fold to four-fold increase in the risk of heart attack, stroke or cardiovascular death. The researchers looked at 31 studies with more than 116,000 patients who took prescription-strength NSAIDs and compared the NSAIDs with other NSAIDS or a placebo. They found that ibuprofen (Advil) carries the highest risk of stroke, etoricoxib (which is not sold in the U.S.) carries the highest risk of cardiovascular death, and rofecoxib (Vioxx, which was withdrawn from the market) has the highest risk of heart attack. They found that naproxen (Aleve) is the safest of the NSAIDs, but that it still carries some cardiovascular risk.
For years, doctors have exercised caution when prescribing NSAIDs for chronic pain relief because of their well-known risk for causing ulcers and serious bleeding in the stomach and GI tract. After a study found that Vioxx, a Cox-2 inhibitor, carried a significant increase in the risk of heart attack and stroke, doctors began to wonder if other pain-relieving medications had heart risks, as well. By the time Merck withdrew Vioxx from the market in September 2004, the drug had caused a reported 60,000 deaths worldwide. A study published in the Archives of Internal Medicine in 2010 found that people taking opioid drugs, which have long been used to treat pain, also have an elevated risk of heart attack compared to NSAIDs. Many clinicians, however, think that NSAID gels and patches may relieve pain without the adverse abdominal and heart effects that pills cause. Others say to simply use NSAIDs judiciously.
So what is a patient, who relies on NSAIDs for symptom relief, to do? The best advice is to talk to your doctor about the risks and benefits of NSAIDs and to disclose any pre-existing heart conditions or risks.