Sunday, October 23, 2011

Cardiovascular safety of non-steroidal anti-inflammatory drugs for arthritis, NSAIDS

The British Medical Journal recently published a network meta-analysis to analyze the evidence on cardiovascular safety of non-steroidal anti-inflammatory medications. These are medications that are commonly used to manage the symptoms of arthritis. They looked at the rates of myocardial infarction (heart attacks), as well as strokes, death from cardiovascular disease, and death from any causes. They included 31 randomized controlled trials with data from over 100,000 patients. Patients included those taking naproxen (Aleve), ibuprofen (Advil), diclofenac (Voltaren), celecoxib (Celebrex), etoricoxib (Arcoxia), rofecoxib (Vioxx), lumiracoxib (Prexige), or placebo (a pill with no biological activity). Compared with placebo, rofecoxib was associated with the highest risk of myocardial infarction, followed by lumiracoxib. Ibuprofen was associated with the highest risk of stroke, followed by diclofenac. Etoricoxib and diclofenac were associated with the highest risk of cardiovascular death. However, none of these drugs appeared to be free of cardiovascular risk. Among them, naproxen seemed to be the safest. While this study does not indicate that these medications should be avoided, it does suggest that moderate and intermittent use may be advisable to minimize the risk.
See also Drugs for arthritis: the good and the bad and our post on the relative safety of these medications.


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