High-Dose NSAIDs Increase Risk of Cardiovascular Events

High-dosage use of certain commonly used nonsteroidal anti-inflammatory drugs (NSAIDs) has been associated with increased risk of major cardiovascular events, especially myocardial infarction, researchers found.

Colin Baigent, MD, of the University of oxford, and colleagues, performed a meta-analysis of 754 trials of NSAIDSs (including selective COX-2 inhibitors, or coxibs) to assess the risk of vascular events associated with different dosages of common NSAIDs. 

Coxibs were found to increase the risk of major vascular events by about 33%, with a rate ration of 1.37 (95% CI 1.14-1.66, P=0.0009).

Ibuprofin significantly increased the risk of coronary events, with a 2.22 rate ratio (95% CI 1.10 to 4.48, P=0.0253), but did not increase the risk of vascular events. 

All NSAID use increased the risk of heart failure and upper GI complications.

"Whilst NSAIDs increase vascular and gastrointestinal risks to a varying extent, our analyses indicate that the effects of different regimens in particular patients can be predicted, which may help physicians choosing between alternative NSAID regimens to weigh up which type of NSAID is safest in different patients," they concluded.

–Michael Potts

Reference

Baigent, C. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials [published online ahead of print May 30, 2013] Lancet. doi:10.1016/S0140-6736(13)60900-9