The Uses and Limits of NSAIDs

Several recent studies have raised some new questions about the use of some over-the-counter pain and fever medications for the long-term prevention of heart disease and Alzheimer's.

The drugs in question are part of a group known as NSAIDs (pronounced EN-seds) — Non-Steroidal Anti-Inflammatory Drugs. NSAIDs are effective against inflammation — like steroids such as prednisone — but are much safer for regular use than steroids.

The NSAID group includes aspirin, ibuprofen (marketed under the names Motrin and Advil) and naproxen (Aleve). It does not include acetaminophen (Tylenol), which is effective against pain and fever but not against inflammation — which is a major factor in certain types of pain, such as the ache of rheumatoid arthritis.

So, can NSAIDs really help protect against chronic illnesses? Well, let's address this by looking at the four most common questions that I get about these drugs, and at some of the recent reports concerning them.

Do all of these drugs protect against heart disease like aspirin?

The answer is an important "no." Aspirin is the only one that offers strong protection against heart disease by interfering with blood clot formation and probably acting in other ways we do not understand.

What about recent reports that these drugs may reduce the risk for Alzheimer's disease?

The most dramatic of these reports was a recent Dutch study that suggested that regular and long-term (at least two years) use of some NSAIDs like ibuprofen could reduce the risk of Alzheimer's by as much as 80 percent. However, before recommending that people take NSAIDs for this purpose, I believe we need more precisely done studies.

What about recent reports that taking ibuprofen and aspirin at the same time could interfere with the protective effect of aspirin on the heart?

This study, published in the Dec. 20 issue of the New England Journal of Medicine, is actually quite complicated. For example, it demonstrated that if a baby aspirin was taken two hours before two tablets of ibuprofen, the protective effect of aspirin — at least in the laboratory analysis was basically unaffected.

However, if the ibuprofen was taken before the aspirin, the impact on the protective effect of the aspirin was considerable. Once again, we have a lot more to learn about this possible interaction before making any firm recommendations.

Most experts believe an occasional ibuprofen for, say, a headache should not significantly interfere with the heart protective effect of regular aspirin.

There are many other questions to consider in using these drugs — such as cost and safety. All NSAIDs (including aspirin, of course) can increase the risk for ulcers and bleeding in the gastro-intestinal system, though some newer ones available by prescription (such as Celebrex and Vioxx) are less likely to do so. However, for most people, the much lower cost of older NSAIDs like aspirin, Motrin, Advil and Aleve will make them the drugs of choice.