Rampant NSAID Use Jacks up Heart Attack Risk in Football Players

Nonsteroidal anti-inflammatory drug use among American football players is high, increasing the athlete’s cardiovascular risk, according to a new study.

Previous studies have shown that NSAIDs are associated with adverse cardiovascular outcomes and that they are overused by football players. This is the first study, however, to describe NSAID use patterns and the link to cardiovascular risk in a diverse cohort of high school and collegiate American style football athletes.

The study, “Nonsteroidal Anti-inflammatory Drugs and Cardiovascular Risk in American Football,” published in the December 2020 issue of Medicine & Science In Sports & Exercise, included 226 football players, 60 endurance athletes and 63 nonathletic controls.

All study participants underwent pre-and postseason with echocardiography, vascular applanation tonometry, and clinical data assessment. NSAID use throughout the season was recorded at postseason.

The football players gained weight (Δ 0.86±3.9 kg, p < 0.001), increased systolic blood pressure (SBP, Δ 3.1±12 mm Hg, p < 0.001) and pulse wave velocity (Δ 0.2 ±0.6 m^.s^-1, p < 0.001) decreased E′ (Δ−1.4 ± 2.8 cm·s⁻¹, p < 0.001) across one athletic season.

Seventy-seven percent (n = 173) of the football players reported starting sport-specific NSAID use in middle school and their “weekly” (n = 42.19%) and “daily” (n = 32.14%) use was higher compared with both the endurance athletes (p < 0.001) and controls (p = 0.02).

In addition, the football players’ NSAID use increased in parallel with postseason systolic blood pressure and weight. “Daily” football NSAID users had the highest postseason systolic blood pressure (137 ±13 vs. 128 ±13 mmHg, p = 0.002) and weight (109.0 ±18.6 vs. 95.8 ±20.5 kg, p = 0.002).

In addition, adjusting for player position, systolic blood pressure, pulse wave velocity, and E’, increased weight (odds ratio = 1.04, 95% confidence interval = 1.0-1.08, p = 0.037) was associated with more frequent NSAID use.

The study authors wrote, “Habitual NSAID use commonly begins during adolescence, before full physical maturation, and is associated with cardiovascular risk, particularly increased weight, in American-style football athletes. NSAID use frequency should be considered when risk stratifying high-risk American-style athletes.”