[Cardiovascular risk of non-steroidal anti-inflammatory drugs]

Classical non-steroidal anti-inflammatory drugs (NSAID) and new selective inhibitors of cyclooxygenase-2(Cox-2 inhibitors) have been successfully used for several decades in the treatment of patients with chronic pain. In addition of their well known adverse gastrointestinal effects, these drugs have been recognized during recent years to increase cardiovascular risk. This risk exists with all drugs belonging to these two therapeutic classes and can be explained by a blood pressure increasing effect and the development of endothelial dysfunction. It there therefore necessary to check blood pressure and the renal function before and during administration of a NSAID or a Cox-2 inhibitor, as well as hemoglobinemia in patients exhibiting an increased gastrointestinal risk. International recommendations propose to avoid the use of these drugs in patients at high cardiovascular risk. If not possible naproxen, co-administered or not with a proton pump inhibitor, should be used preferentially, since this drug is the safest with regard to cardiovascular risk.