Can Diclofenac Affect Your Heart? What You Need to Know

Diclofenac and Heart Health: Why You Should Be Careful

The issue of Diclofenac in connection with cardiovascular risk has been a subject of numerous research. NSAIDs are generally effective as analgesics but their usage is not without risk.

One of the most problematic side effects of Diclofenac is its ability to cause cardiovascular events like stroke and heart attacks.

Diclofenac's Impact on Heart Health: Key Factors

So, why does diclofenac cause heart attacks? However, the exact mechanisms by which this increase occurs have not yet been fully established, although there are several theories about it:

Blood Pressure Elevation:

Like other NSAIDs, diclofenac increases blood pressure. So, it is not best for those who already have hypertension because even a slight rise in blood pressure can raise the risk of heart problems.

COX-2 Inhibition:

Diclofenac is an inhibitor of COX-2 that strongly inhibits the action of the enzyme. While relieving pain and inflammation,

it disturbs the balance and level of prostacyclin (vasodilator/inhibitor of platelet aggregation)  and thromboxane (vasoconstrictor/ promoter platelet aggregation).

This consequently creates a thrombotic state that might result in heart attacks or strokes.

Fluid Retention:

NSAIDs can make the body retain fluid thus causing increased blood volume and consequently high blood pressure. In this way,

it puts strain on the heart, especially in individuals with heart failure or a history of other cardiovascular conditions.

Studies and Research on Diclofenac and Heart Health

Several studies have been conducted about the cardiac risks of Diclofenac. These have produced significant insights into the extent of these risks leading to prescription changes in many nations.

The Danish Study (2018)

One of the most important pieces of research undertaken on this subject matter was carried out in Denmark, and published by the BMJ journal in 2018.

The researchers conducted a nationwide cohort study that involved over 6.3 million adults.

The main objective of this study was to compare cardiovascular risks linked with Diclofenac sodium against those associated with alternative NSAIDs and paracetamol.

Key findings from the Danish study include:

Early Risk Appearance:

The elevated risk was observed 30 days after administration of Diclofenac, showing that its use can be harmful even for a short period.

Increased Risk of Cardiovascular Events:

This study showed that using Diclofenac tablets could increase one’s risk of cardiovascular events such as heart attacks or stroke by up to 50%, compared to not using them at all.

On top of what has already been stated, this risk is higher than that posed by other NSAIDs like ibuprofen and naproxen.

More Risk among High-Risk Patients:

The study also showed that the person with pre-existing cardiovascular diseases such as hypertension and previous heart attacks were at a high risk associated with diclofenac’s usage. 

The PRECISION Trial (2016)

Another important article published by The New England Journal of Medicine in 2016 was The PRECISION trial which evaluates the cardiovascular safety of NSAIDs.

In this randomized controlled trial, patients with rheumatoid arthritis or osteoarthritis were added who were already at a high risk of cardiovascular effects.

Also, the heart risks of three NSAIDs were compared in this study, including celecoxib, ibuprofen, and naproxen.

While Diclofenac itself was not studied alone under the PRECISION trial, this finding is relevant because it reports the serious cardiovascular effects posed by COX-2 inhibitors and other non-selective NSAIDs.

Celecoxib had a lower risk of cardiovascular events than ibuprofen and naproxen. However, Diclofenac is a potent COX-2 inhibitor, these results raised concerns about its adverse effects on the heart.

Meta-Analysis of NSAID Use (2011)

This is based on a 2011 meta-analysis published in BMJ whereby data from 31 clinical trials involving more than 116,000 subjects were pooled together.

The object of this analysis is to assess cardiovascular risks from different NSAIDs, particularly Diclofenac. 

Numerous findings originate from the meta-analysis such as:

Diclofenac and Cardiovascular Risk:

The analysis found that taking Diclofenac significantly raised the risk of cardiovascular events similar to rofecoxib (Vioxx), a COX-2 inhibitor, which has been withdrawn from the market due to its high cardiovascular risks.

Dose-Dependent Risk:

It was observed that the risk of cardiovascular events increased with the dose, with higher doses of Diclofenac being associated with greater risks.

Who Should Be Most Concerned About Taking Diclofenac?

Given the evidence associating Diclofenac with an increased risk of cardiovascular events, certain people should be very careful before using it.

Patients Suffering from Pre-Existing Heart Diseases

Patients who have had heart disorders like cardiac arrests, stroke, high blood pressure, or heart failure are more likely to experience adverse cardiovascular effects when they consume diclofenac.

The use of this drug should be avoided or restricted in those individuals and pain management alternatives considered instead.

Persons with Risk Factors for Cardiovascular Disease

Some of the risk factors can increase the likelihood of adverse events with Diclofenac use even if there is no diagnosed cardiovascular condition.

These include a family history of heart disease, smoking, obesity, diabetes, and high cholesterol. People having such risk factors must be cautious while using Diclofenac.

Elderly People

The incidence rate for cardiovascular problems increases as age advances and elderly people are more likely to suffer from these problems.

Before prescribing Diclofenac to elderly patients, healthcare providers should consider its risks and benefits.

Pregnant Women

Though this does not directly link to cardiovascular risk, it’s worth mentioning that generally Diclofenac is not recommended during pregnancy, especially in the third trimester.

The utilization of NSAIDs during pregnancy has been connected with various hazards including premature closure of fetal ductus arteriosus resulting in complications at birth.

Diclofenac Heart Palpitations

Sometimes diclofenac or other NSAIDs cause heart palpitation by affecting the body’s blood pressure and fluid balance.

This sensation of irregular or racing heartbeat is a side effect of diclofenac which can trigger cardiovascular problems. Moreover, if you have a history of heart events, palpitations are a matter of concern for you.

So, if you are taking diclofenac and experiencing heart palpitation, consult your doctor immediately. 

Diclofenac and High Blood Pressure Medication

Diclofenac can interact with drugs used to treat high blood pressure, reducing the anti-inflammatory effect of diclofenac and causing high blood pressure or fluid retention.

Diclofenac also counteracts the effectiveness of antihypertensive medicines, enhancing the risk of heart problems and poor blood pressure control.

So, if you are taking high blood pressure medications, tell your doctor before taking diclofenac to avoid its adverse effects.

Alternative Pain Management Options

In patients who are concerned about their heart health, it is important to find safe and effective alternatives to Diclofenac.

The appropriate pain management will depend on individual factors such as patient health status as well as the underlying medical conditions. Some of the alternatives for pain management are:

Topical NSAIDs

Topical forms of NSAIDs such as diclofenac gel offer pain relief with low levels of the drug being absorbed into the bloodstream.

Is Diclofenac gel safe for heart patients?

The low absorption of diclofenac gel into the bloodstream implies that the drug working is restricted to the affected area only,

reducing the risk of adverse effects including cardiovascular events such as stroke or heart attack even in heart patients.

Topical NSAIDs are best for the treatment of localized pain resulting from osteoarthritis and soft tissue injuries.

Acetaminophen (Paracetamol)

Acetaminophen is the best anti-inflammatory for heart patients and treats mild-moderate pain. It acts as a first line of therapy in pain management and carries less risk of cardiovascular side effects compared to NSAIDs like diclofenac or ibuprofen.

Physical Therapy

Physical therapy plays a crucial role in pain management, especially in musculoskeletal conditions. It includes various techniques such as-

exercise, stretching, and manual therapy, alleviating pain, enhancing function, improving mobility, and eliminating the need for Diclofenac sodium or other painkillers.

Low-Dose Aspirin

Aspirin has mild anti-inflammatory and anti-analgesic effects; however, its low dose is preferred due to its cardioprotective effects.

Although it is less potent than diclofenac, low-dose aspirin is best for patients who require heart protection and pain management.

However, aspirin can also cause gastrointestinal bleeding, so you must take it under the supervision of your doctor. 

Heat and Cold Therapy

For acute pain or injury, the use of heat or cold is also one of the best options for non-pharmacological treatment.

Cold therapy (ice packs) should be applied in the primary stage of an injury to minimize inflammation and swelling while heat therapy (warm packs) on the affected area eases muscle tension and decreases pain.

COX-2 Inhibitors (with Caution)

Selective COX-2 inhibitors like celecoxib have been synthesized to avoid the risk of gastrointestinal events and provide effective anti-inflammatory effects similar to NSAIDs.

Celecoxib is best for pain management in individuals with a lower risk of cardiovascular problems. However, its higher dose can cause heart problems, so take it according to your doctor’s advice and recommendation.

Opioids (with Caution)

If you are suffering from intense pain and other treatments are unable to provide relief, opioids are the best option. Opioids are effective for short-term pain management;

however, they are associated with a higher risk of addiction, dependency, and other adverse effects. So, you must take it under the supervision of your doctor.

Alternative Therapies

Other alternative therapies may include massage, acupuncture, and mindfulness-based stress reduction for pain management.

As for these therapies, their effectiveness is still under debate, yet, some people may experience relief through the utilization of these therapies as forms of pain control strategy.

Wrapping Up

In general, reports indicate that diclofenac is useful for the treatment of diverse types of pains; however, the utilization of this medicine involves various cardiovascular risks, especially among patients who have a history of cardiovascular diseases or risk factors.

The evidence from recent studies and clinical trial results modified the previous presumption about the safety of Diclofenac, letting doctors become more careful while prescribing it.

You can also opt for other pain management options such as topical NSAIDs, acetaminophen, non-pharmacological interventions, and physical therapy to avoid the risk of heart problems.

However, whatever decision you want to make, take it under your doctor’s supervision according to your health, medical history, and risk profile. 

Frequently Asked Questions

Is Diclofenac Bad for the Heart?

High dose or prolonged use of diclofenac is bad for your heart. It increases the risk of heart problems such as strokes, heart attacks, or heart failure, especially in patients with pre-existing cardiovascular problems. 

Is Diclofenac Safe for Cardiovascular Patients?

Diclofenac is not best for patients with cardiovascular problems as it can enhance the chances of strokes or heart attacks. Moreover, tell your doctor about your health condition before taking diclofenac to avoid adverse effects.

Who Should Avoid Diclofenac?

Is diclofenac safe for high blood pressure? Diclofenac is not best for those who have high blood pressure, heart disease, gastrointestinal events, a history of kidney issues, allergic reactions, or strokes.

So, if you have any of these issues, tell your doctor before taking diclofenac to avoid its adverse effects. 

Can Diclofenac Cause Heartburn?

Diclofenac can irritate your stomach lining and cause discomfort, acid reflux, or heartburn. So, if you get any of these effects, consult your doctor immediately. 

Which Is More Harmful, Diclofenac or Ibuprofen?

Diclofenac is more potent and harmful than ibuprofen as it carries the risk of adverse effects like heart, kidney, liver, or digestive tract problems. However, the choice depends on your medical conditions, health profile, age, and other factors. 

References

Nissen, S. E., Yeomans, N. D., Solomon, D. H., et al. (2016). Cardiovascular safety of celecoxib, naproxen, or ibuprofen for arthritis. The New England Journal of Medicine, 375(26), 2519-2529.

Fosbøl, E. L., Gislason, G. H., Jacobsen, S., et al. (2018). Cardiovascular risks associated with the use of diclofenac and other traditional non-steroidal anti-inflammatory drugs: a nationwide cohort study. BMJ, 362, k3426.

Trelle, S., Reichenbach, S., Wandel, S., et al. (2011). Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ, 342, c7086.