[Nonsteroidal anti-inflammatory drugs and the risk of cardiovascular diseases]

Non-steroidal anti-inflammatory drugs act as nonselective inhibitors of the enzyme cyclooxygenase (catalyzes the formation ofprostaglandins), inhibiting both the cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) isoenzymes. Selective COX-2 inhibitors have reduced gastrointestinal related adverse events but increased the risk of cardiovascular diseases. Selective COX-2 inhibitors may tip the natural balance between prothrombotic thromboxane A2 and antithrombotic prostacyclin potentially increasing the possibility of a thrombotic cardiovascular event. Decreased prostacycline synthesis, a vasodilatator and modulator of platelet activation, contributing to platelet aggregation and vasoconstriction. Some studies have suggested that NSAID increase the risk of cardiovascular events and for patients at high cardiovascular risk we should use them with great caution.