Does ibuprofen (Motrin) increase the risk of cardiovascular events?

From the Guidelines

Motrin (ibuprofen) increases the risk of cardiovascular events, particularly with higher doses and longer durations of use, as evidenced by a study published in the Journal of the American College of Cardiology 1. This risk applies to all non-steroidal anti-inflammatory drugs (NSAIDs) except aspirin. The cardiovascular risks include heart attack, stroke, heart failure, and high blood pressure. These risks are higher in people who already have cardiovascular disease or risk factors such as high blood pressure, high cholesterol, diabetes, or smoking. The mechanism behind this increased risk involves ibuprofen's effects on blood clotting, blood vessel function, and fluid retention. Some key points to consider when using Motrin or other NSAIDs include:

• The risk of death associated with the use of ibuprofen is significant, with a hazard ratio (HR) of 1.50 (1.36 to 1.67) compared to non-use 1.
• The American Heart Association recommends a stepped-care approach to pain management, starting with non-pharmacological approaches and acetaminophen, and reserving NSAIDs for situations where initial therapy is insufficient 1.
• For those who need pain relief but have cardiovascular concerns, acetaminophen (Tylenol) may be a safer alternative for short-term pain management.
• If you must use Motrin, it's best to take the lowest effective dose for the shortest possible time, as the risk of cardiovascular events is proportional to COX-2 selectivity and the underlying risk in the patient 2.
• People with existing heart conditions should consult their healthcare provider before using Motrin or other NSAIDs regularly, as the combination of aspirin and ibuprofen may interfere with aspirin's ability to irreversibly acetylate the platelet COX-1 enzyme 2.

From the FDA Drug Label

WARNINGS CARDIOVASCULAR EFFECTS Cardiovascular Thrombotic Events Clinical trials of several COX-2 selective and nonselective NSAIDs of up to three years duration have shown an increased risk of serious cardiovascular (CV) thrombotic events, including myocardial infarction (MI) and stroke, which can be fatal Cardiovascular Thrombotic Events Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal.

Yes, Motrin (ibuprofen) increases the risk of cardiovascular events, including myocardial infarction and stroke, which can be fatal [3] [4].

• The risk may occur early in treatment and may increase with duration of use.
• Patients with known CV disease or risk factors had a higher absolute incidence of excess serious CV thrombotic events.
• To minimize the potential risk for an adverse CV event, use the lowest effective dose for the shortest duration possible.

From the Research

Motrin and Cardiovascular Events

• Motrin, also known as ibuprofen, is a nonsteroidal anti-inflammatory drug (NSAID) that has been associated with adverse effects, including cardiovascular risks 5.
• A study published in the Journal of cardiovascular pharmacology and therapeutics found that over-the-counter formulations of ibuprofen, when used as directed, have little cardiovascular risk 5.
• However, another study published in Expert opinion on drug safety noted that NSAIDs, including ibuprofen, increase the risk of both upper and lower gastrointestinal complications and have a worse cardiovascular profile compared to COX-2 selective agents 6.
• The study also mentioned that naproxen seems safer for the cardiovascular system, but it is one of the NSAIDs with higher gastrointestinal toxicity, whereas ibuprofen may neglect the antiplatelet effect of aspirin 6.
• It is essential to individualize the prescription of type and dose of NSAIDs based on the stratification of the cardiovascular and gastrointestinal risk of patients 6.

Comparison with Other Studies

• A study published in The New England journal of medicine compared the effectiveness of aspirin dosing in cardiovascular disease and found no significant differences in cardiovascular events or major bleeding between patients assigned to 81 mg and those assigned to 325 mg of aspirin daily 7.
• Another study published in Circulation. Cardiovascular quality and outcomes investigated the guideline-directed statin intensity and associated outcomes in a large health care system and found that over one-third of statin-eligible patients were not prescribed statin therapy 8.
• A cost-utility analysis published in Annals of internal medicine found that aspirin is less costly and more effective for preventing coronary heart disease events in middle-aged men whose 10-year risk for coronary heart disease is 7.5% or higher 9.