PITTSBURGH (KDKA) — Pain-killing anti-inflammatory drugs like Celebrex and Advil — medicines called NSAIDS (non-steroidal anti-inflammatory drugs) and COX-2 inhibitors — are linked to a higher risk of heart attack, stroke or death.

“Patients with heart disease have cardiac events and were they on NSAIDS or some of these other medications at the time? Yes. Is that the cause, or is it because of their underlying cardiovascular disease? It’s hard to say,” says Dr. George Gabriel, a cardiologist at Allegheny General Hospital.

In a study in the British Medical Journal, researchers reviewed 31 studies of more than 100,000 patients and a variety of anti-inflammatories.

Especially at higher doses and with longer length of use, they found a small increased risk of heart attack, stroke or death – just one of these events for every 100 years of patient life.

Diclofenac had the highest risk and naproxen had the least.

“It’s a difficult situation, because a lot of our patients need chronic pain medication,” Dr. Gabriel remarks.

It’s a problem because he would like for his patients to be active, which can be painful with arthritis and other conditions.

“Increasing your activity level is good for their cardiovascular system,” he says.

The study suggests cardiovascular risk should be considered when using these medicines.

“I tell them try to limit the amount they take, the lowest dose possible for the least amount of time,” he advises.

Because the increased risk is so slight, the benefit of taking these drugs, in many cases, may outweigh the risk.

Every group of medication for pain has some downside to it — even Tylenol or narcotics. For people with heart disease risk factors and pain issues, an individualized approach would be best.