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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NSAIDs and cardiovascular risk

The Medicines and Healthcare products Regulatory Agency (MHRA) has highlighted the results of an international study led by the Hull York Medical School that aimed to assess the cardiovascular risks of non-steroidal anti-inflammatory drugs (NSAIDs).

This study included data from more than 2,700,000 individuals included in 51 studies. The data set allowed analysis of 184,946 cardiovascular events. The relative risks of cardiovascular events for several NSAIDs were calculated as follows:

  • Rofecoxib 1.45 (95% CI 1.33 - 1.59)
  • Diclofenac 1.40 (1.27 - 1.55)
  • Ibuprofen 1.18 (1.11 - 1.25)
  • Naproxen 1.09 (1.02 - 1.16)
  • Celecoxib 1.26 (1.09 - 1.47) - from a data subset
  • Etoricoxib 2.05 (1.45 - 2.88) - from a data subset
  • Etodolac 1.55 (1.28 - 1.87) - from a data subset
  • Indomethacin 1.30 (1.19 - 1.41) - from a data subset

The authors conclude that, "among widely used NSAIDs, naproxen and low-dose ibuprofen are least likely to increase cardiovascular risk". They also note that the data for indomethacin casts doubt on its continued use.

Action: As noted by the MHRA, the findings presented by this study are not new but the relative risk information may prove useful. Current advice remains the same; Use an NSAID with the lowest risk, for the shortest time and at the lowest dose necessary to control symptoms.

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2 Comments to “NSAIDs and cardiovascular risk”

  1. Hmmm.....(justifiable) doubts about indometacin yet etoricoxib seems to have carved itself a niche in acute gout and it more than doubles CV risk.....shouldn't we be casting some doubt here too?

    Comment by Andrew Martin — September 30, 2011 #

    1. @Andrew,

      I quite agree. Even for conditions such as gout where the treatment duration is short it would still be prudent to use NSAIDs of the lowest risk.

      Comment by Matthew Robinson — September 30, 2011 #

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