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

From the Guidelines

Motrin (ibuprofen) may increase the risk of heart disease, particularly when used at high doses or for extended periods, as evidenced by studies such as 1 which found a dose-dependent increase in risk of death and rehospitalization for myocardial infarction associated with ibuprofen use. Regular or long-term use of Motrin and other nonsteroidal anti-inflammatory drugs (NSAIDs) has been associated with an increased risk of heart attack, stroke, and heart failure, especially in people with existing cardiovascular conditions. This risk appears to be dose-dependent, meaning higher doses and longer durations of use may carry greater risk, as supported by the findings of 1 which reported hazard ratios for death associated with ibuprofen use. The mechanism involves how NSAIDs affect the balance of substances that promote and prevent blood clotting and inflammation in blood vessels. People with existing heart disease, high blood pressure, or risk factors for heart disease should be particularly cautious with Motrin use, as advised in 1 and 1. If you need pain relief and have heart concerns, it's advisable to use the lowest effective dose for the shortest time possible, or discuss alternative pain management options with your healthcare provider, in line with the recommendations of 1 and 1. For occasional, short-term use at recommended doses, the cardiovascular risks of Motrin are generally low for most healthy individuals. Some key points to consider include:

• The risk of cardiovascular events associated with NSAID use is proportional to COX-2 selectivity and the underlying risk in the patient, as stated in 1.
• Nonpharmacological approaches are recommended as the first line of treatment, followed by a stepped-care approach to pharmacological therapy, as outlined in 1.
• Analgesic doses of aspirin may be a reasonable option for some patients, but the combination of aspirin and ibuprofen may interfere with aspirin's antiplatelet effect, as noted in 1.

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.

The use of ibuprofen, also known as Motrin, may increase the risk of cardiovascular thrombotic events, including myocardial infarction and stroke. However, it does not directly cause heart disease.

• The increased risk of CV thrombotic events is associated with the use of NSAIDs, including ibuprofen 2 2.
• Patients with known CV disease or risk factors had a higher absolute incidence of excess serious CV thrombotic events 2.
• To minimize the potential risk for an adverse CV event, use the lowest effective dose for the shortest duration possible 2.

From the Research

Motrin and Heart Disease

• Motrin, also known as ibuprofen, is a nonsteroidal anti-inflammatory drug (NSAID) that has been associated with an increased risk of cardiovascular events, including heart disease 3.
• The use of NSAIDs, including Motrin, has been linked to an increased risk of thrombotic events, heart failure, and elevated blood pressure 3.
• However, it is essential to note that the risk of cardiovascular events associated with NSAID use varies depending on the specific medication, dose, and individual patient factors 4, 5.

Mechanism of Action

• NSAIDs, including Motrin, work by inhibiting the production of prostaglandins, which are hormone-like substances that play a role in pain and inflammation 6.
• The inhibition of prostaglandins can also affect platelet function, which can increase the risk of cardiovascular events 6, 7.
• Some NSAIDs, such as ibuprofen, have been shown to interfere with the antiplatelet effect of aspirin, which can further increase the risk of cardiovascular events 6, 7.

Individual Risk Factors

• Patients with pre-existing cardiovascular disease, such as heart failure or coronary artery disease, may be at higher risk of cardiovascular events when taking NSAIDs, including Motrin 3, 5.
• Other individual risk factors, such as age, dose, and duration of NSAID use, can also affect the risk of cardiovascular events 4, 5.
• Healthcare professionals should carefully evaluate the benefits and risks of NSAID use in individual patients and consider alternative treatments when possible 3, 5.