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Cardiovascular effects of common analgesics
1HT Ong Heart Clinic, 251C Burma Road, 10350 Penang, Malaysia. ongheanteik@gmail.com.
The Medical Journal of Malaysia
|May 1, 2013
Summary
Non-steroidal anti-inflammatory drugs (NSAIDs) and coxibs can increase cardiovascular risks by inhibiting cyclooxygenase enzymes. Naproxen and celecoxib appear to have the lowest cardiovascular risks among NSAIDs and coxibs, respectively.
Area of Science:
- Pharmacology
- Cardiovascular Medicine
- Pain Management
Background:
- Cyclooxygenase (COX) enzymes produce prostaglandins involved in inflammation, pain, and gastric protection.
- Classical non-steroidal anti-inflammatory drugs (NSAIDs) inhibit both COX-1 and COX-2, risking gastric damage.
- Coxibs selectively inhibit COX-2, reducing pain but potentially increasing thrombosis by blocking endothelial COX-2's antithrombotic function.
Purpose of the Study:
- To review the cardiovascular risks associated with various analgesics, including NSAIDs and coxibs.
- To compare the cardiovascular safety profiles of different NSAIDs and coxibs.
- To identify patient populations at high risk for analgesic-induced cardiovascular events.
Main Methods:
- Review of existing literature on the cardiovascular effects of analgesics.
- Analysis of cardiovascular risk profiles for specific NSAIDs (diclofenac, naproxen) and coxibs (rofecoxib, valdecoxib, enterocoxib, celecoxib).
- Identification of risk factors for adverse cardiovascular events in patients using analgesics.
Main Results:
- Coxibs rofecoxib and valdecoxib were withdrawn due to cardiovascular events. Enterocoxib carries the highest cardiovascular risk among available coxibs, while celecoxib has the lowest.
- NSAIDs also increase cardiovascular events, with diclofenac posing the highest risk and naproxen the lowest.
- Paracetamol and corticosteroids can induce hypertension; steroids also have adverse cardiac metabolic and fluid retention effects. Aspirin's anti-thrombotic effect is counteracted by risks of GI bleeding, fluid retention, and nephrotoxicity.
- High-risk patients include the elderly and those with heart failure, hypertension, chronic renal disease, COPD, and a history of cardiovascular events.
Conclusions:
- Analgesic use, particularly NSAIDs and coxibs, is associated with significant cardiovascular risks.
- Patient selection and monitoring are crucial, especially for high-risk individuals, as adverse events can occur rapidly.
- Naproxen and celecoxib represent lower-risk options within their respective drug classes regarding cardiovascular safety.
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