1. How NSAIDs affect the heart
Nonsteroidal anti-inflammatory drugs (NSAIDs) work by blocking enzymes called cyclooxygenases (COX-1 and COX-2) that produce prostaglandins. These prostaglandins mediate inflammation and pain but also help maintain normal kidney function and protect the lining of blood vessels.
When NSAIDs inhibit these enzymes, they can interfere with the kidneys’ ability to excrete sodium and water effectively. This leads to fluid retention, which increases blood volume and raises blood pressure. For seniors over 60, whose cardiovascular and renal systems may already be less efficient, this extra fluid burden can strain the heart.
This added pressure can reduce the heart’s pumping efficiency, particularly in individuals with underlying heart conditions. The stiffer blood vessels and less flexible kidneys common with aging make this effect more pronounced, increasing the risk of heart failure exacerbations or hypertension.
2. Risks of long-term use
Long-term daily use of NSAIDs carries a higher risk of adverse cardiovascular effects compared to short-term or occasional use. Sustained fluid retention can gradually worsen high blood pressure and lead to swelling in the legs and ankles, known medically as peripheral edema.
For older adults, this can translate into a greater chance of developing or worsening heart failure symptoms. Research shows that chronic NSAID use can double the likelihood of hospitalization for heart failure in seniors, especially in those with pre-existing cardiac issues.
Other potential risks include increased risk of heart attack or stroke due to effects on blood clotting and vascular function, although these risks vary depending on the specific NSAID and individual health profile.
Because of these risks, doctors often recommend the lowest effective NSAID dose for the shortest possible duration, and only after carefully assessing individual cardiovascular risk factors.
