J Pharm Pharmacogn Res 2(Suppl. 1): S28, 2014
Special supplement with the abstract book of LATINFARMA 2013
C 009: CARDIOVASCULAR RISK OF NONSTEROIDAL ANTIINFLAMMATORY DRUG FREQUENTLY USED
Introduction: The non-steroidal anti-inflammatory drugs (NSAIDs) are an important part of treatment for many people with painful and inflammatory conditions and are amongst the most commonly used drugs worldwide. The extent to which an NSAID inhibits the respective cyclooxygenase isoforms (COX-1 and COX-2) may be related to cardiovascular risk (CVR). There is a growing body of evidence that most NSAIDs are associated with an increased CVR, some more than others.
The aim was to review: the cardiovascular toxicity of different NSAIDs, epidemiology of use and recommendations of published guidelines.
Results: In the VIGOR (2000) study was observed that rofecoxib was associated with a fourfold increase in the incidence of myocardial infarction (MI) compared with naproxen. It was the first evidence of CVR of a coxib. Six years later, a meta-analysis of randomised trials, and a systematic review of the observational studies found that coxibs, diclofenac and possibly ibuprofen were associated with higher CVR than naproxen. Those were the first evidences of CVR of traditional NSAIDs. In 2011, a network meta-analyses of randomised trials, and the biggest systematic review of the observational studies reported similar results. The highest CVR were seen with coxibs and diclofenac and the lower with naproxen. In 2013, Bainget´s meta-analyses indicated that in high-dose, the CVR of diclofenac and possibly ibuprofen are comparable to coxibs, whereas high-dose naproxen is associated with less vascular risk than other. For every 1000 patients allocated to a year of treatment with a coxib regimen or high-dose diclofenac, about three would have a MI, of which one would be fatal. However, NSAIDs with a high CVR are still widely used. Diclofenac and etoricoxib together account for approximately one-third of all sales of NSAIDs in several countries.
Conclusions: While the benefits of NSAIDs for the treatment of pain outweighs their risks, their use should be at the lowest effective dose for the shortest possible time. Where pharmacological treatment is required for patients at risk of cardiovascular complications paracetamol, naproxen or aspirin is recommended and coxibs or diclofenac should be avoided.