CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

January 12th, 2011

Large Meta-Analysis Explores Cardiovascular Safety of NSAIDs

A large network meta-analysis has found “little evidence” to suggest that any of the commonly used NSAIDs or COX 2 inhibitors are safe in terms of cardiovascular risk. In a paper published in BMJ, Sven Trelle and colleagues analyzed data from 31 trials in which patients receiving an NSAID were compared to another NSAID or placebo. Rofecoxib was associated with the highest risk of MI while naproxen appeared to be the safest of the agents studied. The authors concluded that “options for the treatment of chronic musculoskeletal pain are limited and patients and clinicians need to be aware that cardiovascular risk needs to be taken into account when prescribing.”

In an accompanying editorial, Wayne Ray writes that the limitations of the meta-analysis mean the results “should be interpreted with caution.” Although naproxen appears to be the safest agent it may require the concomitant use of a gastroprotective agent. Ray writes that “drugs for symptomatic relief must be evaluated with regard to the target symptoms as well as less frequent yet serious adverse effects. NSAIDs are not an ideal treatment with respect to efficacy or safety.”

Categories: General
Tags: , ,


You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

2 Responses to “Large Meta-Analysis Explores Cardiovascular Safety of NSAIDs”

  1. ROBERT LAUER, md, PhD says:
    January 12, 2011 at 5:29 pm

    We have known for years that all NSAIDS have side effects which,given in a large enough population, will result in disease and death. If you provide enough people with a drug which causes fluid retention, raises blood pressure and negatively affects kidney function, what else would you expect. Add to that the possibility of GI toxicity/bleeding, and the risks are even higher. Vioxx was a terrific antiinflammatory drug – it make “heroes” out of PCP’s, rheumatologists and orthopedic surgeons. But the price paid was dear because patients were taking the drug too often, too long, and it was given to a population of patients at high risk (older patients with arthritis).

    Competing interests pertaining specifically to this post, comment, or both:
    None

  2. Kishaloy Sur, MBBS says:
    January 13, 2011 at 8:33 am

    Renal adverse events are not evaluated. Many elderly,diabetic & history of CHD or CVD are risk of AKI as well as increase blood pressure lead to acute MI & Heart failure. Chronic use of NSAIDs may contribute to CKD along with other known risk factor like uncontrolled diabetes & hypertension.
    Renal safety of NSAIDs are ignored.Even with Naproxen, along with GIT event renal adverse effect should be evaluated in prospective studies. Those studies are urgently needed.Otherwise full spectrum of adverse effect will remain incomplete.