Cardiovascular risk with non-steroidal anti- inflammatory drugs

January 01, 0001

Cardiovascular risk with non-steroidal anti- inflammatory drugs

Randomised trials have highlighted the cardiovascular risks of non-steroidal anti-inflammatory drugs (NSAIDs) in high doses and sometimes atypical settings. Here, the researchers from the UK, Canada and Australia provide estimates of the comparative risks with individual NSAIDs at typical doses in community settings. They performed a systematic review of community-based controlled observational studies. They conducted comprehensive literature searches, extracted adjusted relative risk (RR) estimates, and pooled the estimates for major cardiovascular events associated with use of individual NSAIDs, in different doses, and in populations with low and high background risks of cardiovascular events. Thirty case-control studies included 184,946 cardiovascular events, and 21 cohort studies described outcomes in greater than 2.7 million exposed individuals.

Of the extensively studied drugs (ten or more studies), the highest overall risks were seen with rofecoxib, 1.45, and diclofenac, and the lowest with ibuprofen, 1.18 and naproxen. In a sub-set of studies, risk was elevated with low doses of rofecoxib, 1.37, celecoxib, 1.26 and diclofenac, 1.22, and rose in each case with higher doses. Ibuprofen risk was seen only with higher doses. Naproxen was risk-neutral at all doses. Of the less studied drugs etoricoxib, 2.05, etodolac, 1.55, and indomethacin, 1.30 had the highest risks. RR estimates were constant with different background risks for cardiovascular disease and rose early in the course of treatment.

The researchers concluded: "This review suggests that among widely used NSAIDs, naproxen and low-dose ibuprofen are least likely to increase cardiovascular risk. Diclofenac in doses available without prescription elevates risk. The data for etoricoxib were sparse, but in pair-wise comparisons this drug had a significantly higher RR than naproxen or ibuprofen. Indomethacin is an older, rather toxic drug, and the evidence on cardiovascular risk casts doubt on its continued clinical use."

Is this about the best of the least worse (although these agents have their place)?

For the full abstract, click here.

PLoS Medicine 11 September 2011 © 2011 McGettigan, Henry
ardiovascular Risk with Non-Steroidal Anti- Inflammatory Drugs: Systematic Review of Population-Based Controlled Observational Studies. Patricia McGettigan and David Henry. Correspondence to David Henry: david.henry@ices.on.ca

Category: K. Circulatory. Keywords: cardiovascular, risk, non-steroidal anti-inflammatory, drugs, systematic reviews of observational studies, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 15 November 2011

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