NSAIDs and Cardiovascular Disease

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for pain relief and are available as over the counter products as well as by prescription. A recently published article systemically reviewed available evidence and confirms that rofecoxib (Vioxx©) is associated with a significantly increased risk of cardiovascular events; the data also suggests that diclofenac (Voltaren ©) poses an equivalent risk to patients. Doclofenac is available without a prescription in Europe.

When rofecoxib was taken off the market in 2004 there were questions about the risks of other NSAIDs. Naproxen (Naprosyn ©, Aleve ©, Napralen ©, Anaprox ©) was consistently shown to be safe, even at high doses, suggesting it should be the NSAID of choice in patients with increased cardiovascular risk. Naproxen was shown to be safer than ibuprofen (Advil ©, Motrin ©), with the risk of cardiovascular events increasing with ibuprofen at daily doses ranging from 1200 mg to 1600 mg. If ibuprofen is used for high-risk patients, the authors state that the dose should be kept low. If a higher dose is needed, the patient should be switched to naproxen.

Celecoxib (Celebrex ©) had an increased risk at high and low doses and should not be used at all in patients at high risk of cardiovascular disease. For patients at very low risk, it probably doesn’t matter very much which drug is used.

McGettigan P, Henry D. Cardiovascular Risk with Non-Steroidal Anti-Inflammatory Drugs: Systematic Review of Population-Based Controlled Observational Studies.  PLoS Med 2011: DOI:10.1371/journal.pmed.1001098. Available at  www.plosmedicine.org.