NSAIDs (nonsteroidal anti–inflammatory drugs) are medications commonly used to reduce pain and inflammation. They are one of the most commonly used classes of drugs in the world, with more than 17 million Americans using NSAIDs on a daily basis.  Common over-the-counter NSAIDs include aspirin, ibuprofen and naproxen. Certain types of NSAIDs (e.g. celecoxib, diclofenac) are available only by prescription.

There are many types of NSAIDs that vary in potency, action and potential side effects. Although NSAIDs are primarily used to treat pain, inflammation and fever, aspirin also offers a preventive function. It is the only NSAID that can help inhibit blood clotting for an extended period of time. For this reason, it is considered one of the best drugs to help prevent blood clots that can cause heart attacks and strokes.

In 2005, the U.S. Food and Drug Administration (FDA) issued the following warning about NSAIDs:

• All NSAIDs except aspirin increase the risk of serious adverse cardiovascular events, such as heart attack or stroke.
  
  
• All NSAIDs including aspirin have the risk of serious and potentially life-threatening gastrointestinal bleeding.
  
  
• NSAIDs should not be given to patients immediately after coronary artery bypass graft.

During the past several years, one class of NSAIDs known as COX-2 inhibitors has attracted significant media attention. These prescription drugs, including celecoxib, rofecoxib and valdecoxib, were initially approved by the FDA for the treatment of acute pain. They were frequently prescribed for arthritis patients. In September 2004, however, rofecoxib was voluntarily removed from the market by its manufacturer after a study linked it to increased risk for heart attack. Similarly, valdecoxib was voluntarily removed from the market in April 2005 for concerns over adverse cardiovascular effects. In addition, a strong “black box” warning was added to celecoxib (Celebrex), which is the only COX-2 inhibitor still on the market.

Current research provides evidence that selective COX-2 inhibitors have an increased risk of adverse cardiovascular side effects, including hypertension, heart attack, stroke and heart failure. Studies are ongoing to determine the extent of risk associated with this class of drugs and their limitation for usage among heart patients.

In general, patients are encouraged to speak with their physicians before beginning any long-term NSAID treatment – including taking daily aspirin. The American Heart Association recommends that physicians weigh the benefits and risks before prescribing any pain killer. The AHA further suggests limiting the use of COX-2 inhibitors in patients with cardiovascular disease (or those at risk for disease) due to their potential side effects. The drugs should be provided only to those patients who have no other treatment alternatives. It is recommended that they be used in the lowest possible dose for the shortest amount of time.