Journals Club - NSAIDs and cardiovascular disease risk

Dr Louise Newson brings us up to date with the latest research and guidance on cardiovascular problems

Stenosis of the left coronary artery (Photograph: SPL)
Stenosis of the left coronary artery (Photograph: SPL)

Curriculum statement 15.1: Cardiovascular problems

Key trials

  • There has been increasing concern about the potential for NSAIDs to cause or aggravate thrombotic cardiovascular disease, even with relatively short-term use (MHRA and CHM. Drug safety update. 2009; 2 (7)).
  • Observational data has demonstrated that this risk appears to be greatest with high doses of diclofenac (150mg a day) and ibuprofen (2400mg a day). Naproxen and ibuprofen at lower doses (<1000mg per day and <1200mg a day respectively) do not have significant cardiovascular risk (MHRA. Non-steroidal anti-inflammatory drugs and cardiovascular risks in the general population. January 2006).
  • A recent study investigated the risk of cardiovascular events in association with NSAIDs for the general population. The results supported the view that an increase in thrombotic risk applies to all NSAIDs users, irrespective of their baseline risk, and not only to chronic users (Clin Pharmacol Ther 2009; 85: 190-7).
  • A recent study has shown that the majority of patients with osteoarthritis requiring NSAIDs for pain control had high cardiovascular risk factors (Ann Rheum Dis 2010; 69: 1453-8).

Evidence base

Guidelines

KEY POINTS
  • NSAIDs are associated with an increased cardiovascular risk.
  • All NSAIDs should be prescribed at the lowest dose for the shortest time.
  • High doses of diclofenac seem to be associated with the greatest cardiovascular risk.
  • Contributed by Dr Louise Newson, a GP in the West Midlands

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