Coming down with the flu or even just a bad cold often has us reaching for the Advil, but a new research study indicates the possibility for the main ingredient in Advil and other common pain relievers to react negatively with respiratory infections, putting a sick person at an increased risk of heart attack.
The new study, from the Infectious Diseases Society of America, identified nonsteroidal anti-inflammatory drugs (NSAIDs) as the pain relievers that increase risk of heart attack when taken by a person plagued with a respiratory infection like a cold or flu-like virus. NSAIDs are common and include multiple familiar brands:
- Aspirin (Bayer, Bufferin)
- Ibuprofen (Advil, Motrin)
- Naproxen (Aleve, Anaprox DS, Naprosyn)
- Celecoxib (Celebrex)
These drugs work to alleviate both pain and inflammation by blocking bodily enzymes that produce fatty acids called prostaglandins. Experts estimate that more than 30 million people worldwide use NSAIDs every day.
"Physicians should be aware that the use of NSAIDs during an acute respiratory infection might further increase the risk of a heart attack," said study author Cheng-Chung Fang, MD
Fang and the team from the Infectious Diseases Society of America conducted an observational study based on claims from Taiwan's National Health Insurance Program, which was conducted between 2005 and 2011. All in all, the study contained data from almost ten thousand patients, all who had been hospitalized at some point for a heart attack.
Researchers asked this question: do two potential cardiac risk factors (acute respiratory infection and NSAID use) have a combined influence on heart attack risk? To find out, they compared heart attack risks over time among patients in the study. They saw that there was a stronger association with heart attack risk when both risk factors were present.
They came to this conclusion by examining different groups of people under different circumstances. Compared to patients without an acute respiratory infection and who were not taking NSAIDS, all other combinations of the two risk factors increased risk of heart attack in some way:
- 3.4-fold increase in patients using over-the-counter NSAIDs while infected with an acute respiratory infection
- 7.2-fold increase in patients receiving NSAIDs through an IV in the hospital
- 2.7-fold increase in patients ill with an acute respiratory illness but not taking NSAIDs
- 1.5-fold increase in patients taking NSAIDs but healthy otherwise
This is the first study to examine the potential dual effect on heart attack risk of both acute respiratory infection and NSAID use.
Potentially a safer alternative would be drugs containing acetaminophen as the pain relieving ingredient, like Tylenol, Fang suggested. Acetaminophen treats pain and inflammation in a different way than NSAIDs that might make it safer for use alongside a chronic respiratory infection.
Scientists in a related editorial commentary added that "clinicians should consider both medical conditions and existing medications when prescribing NSAIDs for symptomatic acute respiratory infection relief.”
Fang’s study was recently published in the Journal of Infectious Diseases.
Sources: Infectious Diseases Society of America, Spine-health, American College of Rheumatology, Expert Review of Cardiovascular Therapy, U.S. FDA