Maximum Wellness, Episode 77: Some Football Players Have Increased Cardiovascular Risk with NSAID Use

Anyone who’s been involved in athletics at any level—professional, college, recreational, or those older individual with the reoccurring aches and pains of general living—appreciates the benefits of over-the-counter non-steroidal anti-inflammatories (NSAIDs), or the prescription version, as first-line pharmaceutical drugs to treat pain and localized inflammation—under physician guidance.

These medications inhibit cyclooxygenase enzymes, which are responsible for the discomfort associated with overuse issues.

Like a financial statement, which lists both assets and liabilities, NSAIDs have their own negative aspects, when overused. Those complications, with chronic or overuse, may include cardiovascular (CV) outcomes, hypertension, coronary heart disease, atrial fibrillation, and congestive heart failure, especially with high-risk people.

As it pertains to a higher risk population—like American-style football (ASF) athletes of larger sizes, such as the offensive and defensive linemen, retired ASF players, and those ASF players with numerous orthopedic injuries in their medical history, all who later in life may have a higher incidence of hypertension and cardiovascular disease—NSAID use may be contraindicated.

According to Nonsteroidal Ant-Inflammatory Drugs and Cardiovascular Risk in American Football, which appeared in the December 2020 issue of Medicine & Science in Sports & Exercise, “ASF participation is associated with the development of early hypertension and acquired pathologic CV phenotypes—all associated with significant weight gain. Epidemiologic data also suggest increased CV mortality among retired professional ASF athletes, who had the largest playing time body mass index (BMI).

There are still uncertainties, as it pertains to habitual NSAID use and increased CV risk in AFS.

Researchers from Emory University, Georgia Institute of Technology, Woodward Academy in Atlanta, and the Cardiovascular Performance Program at Massachusetts General Hospital in Boston, “sought to characterize NSAID use patterns and the association with cardiovascular risk in a diverse cohort of high school and collegiate ASF athletes.”

The testing group of young athletes included a total of 226 ASF players, 60 endurance athletes, and 63 nonathletic controls, who were studied pre and postseason. Echocardiography, vascular applanation tonometry, and clinical data assessment were obtained. Qualitative NSAID use throughout the season was recorded at postseason.

It was determined that, “within a large cohort of combined HS and collegiate ASF athletes, habitual NSAID use was more common among those with established CV risk factors, and importantly, increased weight across the ASF season was associated with an increased frequency of NSAID use.”

The researchers also said, “second, and just as concerning within this diverse ASF cohort, sport-related ASF NSAID use more commonly began early, in middle school, before full physical maturation.”

It was concluded that, “our data suggest that increased weight, a critical pathologic factor linking early ASF-associated CV risk with adverse long-term outcomes, is also associated with increased NSAID use during competitive ASF training.”

“Taken together, commented the researchers, “we believe that our findings provide compelling rationale that habitual NSAID use may adversely affect CV risk among competitive ASF athletes and should therefore be considered in the CV risk stratification of high-risk ASF athletes.”

As with any medication—prescription or over-the-counter—it’s best to be used under the guidance of your personal physician, in order to avoid potential contraindications or complications.

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