What are the cardiovascular risks from NSAIDs?

January 01, 0001

What are the cardiovascular risks from NSAIDs?

The cardiovascular risk with non-steroidal anti-inflammatory drugs (NSAIDs) is a concern, and has contributed to some drugs being removed from certain markets. This group of Swiss researchers sought to analyze the evidence on cardiovascular risk of NSAIDs via a metanalysis of large scale randomized placebo-controlled trials. They searched bibliographic databases, conference proceedings, study registers, the Food and Drug Administration website, reference lists, and the Science Citation Index, and also received additional data provided by the makers of celecoxib and lumiracoxib. The primary outcome was myocardial infarction. Secondary outcomes included stroke, death from cardiovascular disease, and death from any cause.

The researchers report: "31 trials in 116,429 patients with more than 115,000 patient years of follow-up were included. Patients were allocated to naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib, lumiracoxib, or placebo. Compared with placebo, rofecoxib was associated with the highest risk of myocardial infarction (rate ratio 2.12), followed by lumiracoxib (2.00). Ibuprofen was associated with the highest risk of stroke (3.36), followed by diclofenac (2.86). Etoricoxib (4.07) and diclofenac (3.98) were associated with the highest risk of cardiovascular death."

The researchers concluded: "Although uncertainty remains, little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms. Naproxen seemed least harmful. Cardiovascular risk needs to be taken into account when prescribing any non-steroidal anti-inflammatory drug."

This large meta-analysis finds appreciable cardiovascular risk with NDAIDs, which must be weighed when considering their use.

For the full abstract, click here.

BMJ 342:c7086, 11 January 2011
© 2011 BMJ Publishing Group Ltd.
Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. Sven Trelle, Stephan Reichenbach, Simon Wandel, et al. Correspondence to P Jüni: juni@ispm.unibe.ch

Category: K. Circulatory. Keywords: NSAIDs, myocardial infarction, stroke, naproxen, cardiovascular risk, systematic review with meta-analysis, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 25 January 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.