6. Vessel stiffness and constriction
As we age, blood vessels naturally become stiffer, reducing their ability to dilate properly. NSAIDs exacerbate this by blocking prostaglandins that support vascular relaxation, causing further constriction and increased arterial stiffness.
This stiffening raises systolic blood pressure and increases the workload on the heart. Over time, it contributes to left ventricular hypertrophy and chronic cardiovascular stress, increasing the risk of heart failure and other complications.
7. Fluid retention effects
NSAIDs promote sodium and water retention by interfering with kidney prostaglandins that regulate renal blood flow and excretion. This fluid retention increases blood volume and central venous pressure, further burdening the heart and exacerbating hypertension.
Clinically, this manifests as swelling in the ankles and legs, rapid weight gain, and worsening shortness of breath. Fluid retention is a key reason why heart failure admissions rise with NSAID use in seniors.
8. Platelet clotting imbalance
While low-dose aspirin inhibits platelet aggregation and reduces clot risk, most other NSAIDs do not provide this protective effect. Instead, they disrupt the balance of prostaglandins that regulate clotting, often favoring a pro-thrombotic state.
This imbalance increases the risk of blood clots forming inside vessels, which can lead to heart attacks, strokes, or pulmonary embolisms. The effect varies by NSAID type and dose but is especially concerning for elderly patients with multiple cardiovascular risk factors.
