Title:Use of Non-Selective Non-Steroidal Anti-Inflammatory Drugs in Relation to Cardiovascular Events. A Systematic Pharmacoepidemiological Review
Volume: 14
Issue: 6
Author(s): Christos Kontogiorgis, Ioannis Valikeserlis, Dimitra Hadjipavlou-Litina, Evangelia Nena and Theodoros C. Constantinidis
Affiliation:
Keywords:
Cardiovascular, safety, adverse events, diclofenac, ibuprofen, naproxen, mefenamic acid, stroke, myocardial
infarction.
Abstract: Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely
used, having numerous indications. However, despite their therapeutic role, they are
associated with serious cardiovascular (CV) adverse events.
Objectives-Methods: This review comprising recent observational studies and metaanalyses
over the past few years aims at updating the assessment of CV adverse
events, namely stroke, myocardial infarction (MI), CV death, atrial fibrillation (AF),
serious bleeding and heart failure related to the use of 4 of the most widely prescribed
NSAIDs: ibuprofen, naproxen, diclofenac and mefenamic acid.
Results: The best safety profile related to MI was found for naproxen, while the worst
safety profile, with excessively increased risk for stroke, MI and major bleeding, was for diclofenac.
Naproxen showed higher risk for major bleeding than ibuprofen and the risk for stroke was slightly higher
than ibuprofen. Regarding heart failure, ibuprofen presented the highest risk while the highest risk for AF
was attributed to the current use of diclofenac. There are few data related to mefenamic acid, which
showed a strong association with increased risk for stroke and a moderately increased risk for MI.
Conclusion: Further research is needed in order to devise new guidelines for safer use of NSAIDs.
