Are NSAIDs Bad for Your Heart?

Updated July 2026

Ibuprofen and naproxen are in almost every medicine cabinet, and most people reach for them without a second thought. But these common painkillers carry a real, FDA-warned risk to your heart and, unlike a lot of faux health scares, this one is worth taking seriously. Here's what you need to know before the next time you grab the bottle.

What are NSAIDs?

They're a class of drugs used to treat pain and inflammation. NSAIDs stands for non-steroidal anti-inflammatory drugs. The over-the-counter ones you know are ibuprofen (Advil, Motrin) and naproxen (Aleve). Prescription versions include celecoxib (Celebrex), salsalate, indomethacin, ketorolac, and diclofenac (Voltaren). Most people have taken one at some point.

Two common painkillers are not NSAIDs and worth distinguishing. Acetaminophen (Tylenol) is not an NSAID and was not part of the FDA's cardiovascular warning. Aspirin, though it has anti-inflammatory properties, was also excluded from that warning; it's a separate story worth its own discussion.

How do NSAIDs raise heart attack and stroke risk?

NSAIDs block an enzyme, COX-2, that ultimately reduces prostacyclin, a chemical that dilates blood vessels and prevents clotting. They also inhibit thromboxane, a chemical that promotes clotting, but to a lesser degree. This can create an imbalance favoring clot formation, and a clot forming in an artery is the event that triggers most heart attacks and strokes. Second, they cause the body to retain sodium, directly and by affecting kidney function. Together with the reduced ability of your blood vessels to dilate, can raise blood pressure, can worsen heart failure, and increases the risk of atrial fibrillation. Nearly a decade ago the FDA strengthened its warning about exactly these risks, and the concern applies even to over-the-counter doses.

How do NSAIDs increase the risk of bleeding?

NSAIDs also block COX-1, which reduces prostaglandin production, a compound that protects the lining of your stomach. This can increase your risk for developing ulcers. The thromboxane inhibition doesn't help (as that might lead to your blood being thinner).

Who is most at risk?

Anyone taking NSAIDs faces some increased risk, but it's highest in people who already have heart disease or its risk factors. That includes anyone with a history of heart attack or stroke, and people with smoking, diabetes, high blood pressure, or high cholesterol.

On the bleeding side, those on blood thinners (such as Eliquis, Xarelto or warfarin) should try to avoid these drugs as even a small disruption in the lining of your stomach could result in the loss of blood. Risk climbs with higher doses and longer use, but it's worth repeating that even short-term, low-dose use can cause harm.

How do you use NSAIDs more safely?

Use them sparingly, at the lowest dose, for the shortest time. For mild pain, consider an alternative like acetaminophen. If you do need an NSAID, take the smallest effective dose for as briefly as possible, and get your heart-disease risk factors under control, since a lower-risk person is a lower-risk NSAID user. And be alert to warning signs while taking them: chest pain, shortness of breath, weakness, or trouble with speech or vision all warrant immediate medical attention. Blood in the stool or stool that is black/tarry are signs of possible serious intestinal bleeding.

None of this means NSAIDs are never appropriate; many people use them without incident. But the strengthened warning is a reminder that every medication carries risk, and the smartest move is always to address the root cause of the pain rather than reflexively reaching for a pill. That philosophy, treating the cause rather than masking it, is what Step One Foods is built around.

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