Over-the-Counter Painkillers Linked to Increased Cardiovascular Risks, New Research Shows

While many consumers assume over-the-counter medications are generally safer than prescription drugs, emerging research reveals that common pain relievers may pose significant cardiovascular risks for certain individuals.

Non-steroidal anti-inflammatory drugs (NSAIDs) — widely used to reduce pain, fever, and inflammation — have been identified as particularly concerning when it comes to potential cardiovascular complications, including elevated blood pressure, stroke, and heart attacks.

“NSAIDs reduce the production of chemicals called prostaglandins,” explains Dr. Maryam Jowza, an anesthesiologist at UNC Health in North Carolina. “These chemicals are involved in inflammation, but they also influence the tone of blood vessels.”

According to Dr. Marc Siegel, Fox News senior medical analyst, NSAIDs can trigger cardiovascular issues through specific mechanisms. “They can lead to high blood pressure, heart attack and stroke via fluid retention and salt retention,” he notes. “This increases volume, puts a strain on the heart and raises blood pressure.”

Common NSAIDs include ibuprofen (such as Advil and Motrin), naproxen (Aleve), aspirin, diclofenac, indomethacin, and celecoxib (Celebrex). Clinical trials have shown that ibuprofen causes the most significant blood pressure increases, followed by naproxen and then celecoxib.

“In general, the increase in blood pressure is more likely with higher doses and longer duration of treatment,” says Dr. Jowza, who also serves as an associate professor in the Department of Anesthesiology at the UNC School of Medicine.

Among NSAIDs, diclofenac has been linked to the highest cardiovascular risk. While ibuprofen can also raise blood pressure and has been associated with increased heart attack and stroke risk, its impact is not as severe as diclofenac. Naproxen carries a lower cardiovascular risk than both ibuprofen and diclofenac, but experts caution it’s not entirely risk-free.

“The practical takeaway is that diclofenac is generally the least favorable choice in patients with elevated cardiovascular risk, and all NSAIDs should be used at the lowest effective dose for the shortest duration,” advises Dr. Nayan Patel, pharmacist and founder of Auro Wellness in Southern California.

Interestingly, aspirin represents an exception among NSAIDs. When taken at low doses under medical supervision, aspirin actually reduces the risk of blood clots. However, at higher doses, it can increase bleeding risk and blood pressure.

Non-NSAID pain relievers, particularly acetaminophen (Tylenol), are commonly used for everyday aches, headaches, and fever but don’t address inflammation. These medications primarily act on the brain’s pain signals rather than targeting inflammation directly.

While acetaminophen was once thought to have minimal cardiovascular effects, recent evidence suggests otherwise. “More recent evidence suggests it can increase blood pressure, especially with higher doses used in the long term,” Dr. Jowza explains, adding that its impact on stroke risk remains less clear.

Certain populations face heightened vulnerability to NSAID-related cardiovascular risks. Those with existing health conditions, including high blood pressure, prior stroke or heart disease, diabetes, or kidney problems, should exercise particular caution.

“These groups are also more likely to experience NSAID-related fluid retention and destabilization of blood pressure control,” notes Dr. Patel. Adults aged 75 and older face amplified risks due to declining kidney function and higher baseline cardiovascular risk.

Medical experts advise seeking immediate medical attention for warning signs such as chest pain, shortness of breath, sudden weakness or numbness, severe headache, confusion, slurred speech, or vision changes. Additional concerning symptoms include rapid blood pressure increases, swelling in the legs, sudden weight gain over a few days, reduced urine output, or worsening shortness of breath.

For those at elevated risk, healthcare professionals recommend exploring non-NSAID approaches whenever possible. “For many patients, this means starting with non-drug strategies such as heat or ice, physical therapy and activity modification,” suggests Dr. Patel. “If medication is needed, acetaminophen is generally preferred over oral NSAIDs from a cardiovascular standpoint.”

Topical NSAIDs may offer a safer alternative for localized joint or muscle pain, providing meaningful relief with significantly lower systemic risk.

Despite these concerns, medical experts emphasize that the overall risk remains very low for most people taking OTC pain relievers on a short-term basis. The danger primarily escalates with long-term, high-dose use.

“I would not hesitate to use an occasional dose if it were a low-risk individual with no prior history of heart attack or stroke,” Dr. Jowza reassures. “I also think short-term use in diabetics and hypertensives who are well-controlled is acceptable.”

For those requiring NSAIDs, doctors recommend regular monitoring of blood pressure and kidney function, as well as limiting dosage to minimize risks. The general message from medical professionals is clear: while occasional NSAID use poses minimal risk for healthy individuals, those with underlying cardiovascular conditions should approach these common medications with appropriate caution.