Cardiovascular events associated with the long-term use of NSAIDs: a review of randomized controlled trials and

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Published on: November 30, 2022

Francesco Salvo1, Stefania Antoniazzi, Mai Duong

  • 1University of Bordeaux, Pharmacology , 146 rue Leo Saignat, 33076 Bordeaux , France +33 557574671 ; +33 557574671 ; nicholas.moore@u-Bordeaux.fr.

Expert Opinion on Drug Safety
|April 5, 2014
PubMed
Abstract

Insights

Non-steroidal anti-inflammatory drugs (NSAIDs) may increase cardiovascular thrombotic event risk, particularly with long-term use of high-dose drugs like rofecoxib and diclofenac. Naproxen appears safer, with most NSAIDs showing a risk ratio below 2.

Area of Science:

  • Pharmacology
  • Cardiovascular Medicine
  • Epidemiology

Background:

  • NSAIDs, particularly rofecoxib, are linked to increased cardiovascular thrombotic events.
  • Risk is associated with COX-2 inhibitory potency, with naproxen being an exception.
  • Hypotheses include prostacyclin/thromboxane imbalance and COX-2-mediated hypertension.

Purpose of the Study:

  • To evaluate the cardiovascular risk associated with NSAID use.
  • To analyze data from clinical trials and observational studies on NSAID cardiovascular safety.

Main Methods:

  • Systematic review of clinical trials and observational studies.
  • Inclusion criteria: studies with follow-up of at least 6 months.
  • Analysis of cardiovascular risk data for various NSAIDs.

Main Results:

  • Ambiguous results regarding long-term NSAID exposure and cardiovascular risk.
  • Increased risk of myocardial infarction or stroke noted with high-dose rofecoxib and possibly diclofenac.
  • Limited risk increase with shorter NSAID exposure (under 30 days) and most other NSAIDs (risk ratio < 2).

Conclusions:

  • Long-term NSAID use, especially high-dose rofecoxib and diclofenac, may elevate cardiovascular risk.
  • Most NSAIDs show a low relative risk, particularly for short-term use.
  • Further research is needed to clarify risks associated with long-term use of most NSAIDs.

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