Clear Cardiovascular Risk with NSAID (Non-Steroidal Anti-Inflammatory Drug) Use
A very large-scale meta-analysis published last week by the British Medical Journal (BMJ) confirmed that use of NSAIDs (non-steroidal anti-inflammatory drugs) increases risk of heart attack or stroke.
Incredibly, there has been an eerie media silence on this important study, so I thought I'd highlight some of the details.
Data from 31 high-quality, randomized controlled trials involving a total of 116,429 patients with 117,218 patient years of follow-up were covered in the analysis. The following drugs were analyzed in comparison to one another and to placebo:
- ibuprofen (e.g. Advil; Motrin)
- celecoxib (e.g. Celebrex)
- rofecoxib
- lumiracoxib
- etoricoxib
- diclofenac
- naproxen (e.g. Anaprox; Aleve)
NSAIDs are among the most widely prescribed pharmaceuticals, accounting for an estimated 5% of physician visits in the U.S. However, the following findings should be considered before prescribing or taking NSAIDs:
- Ibuprofen, celecoxib, rofecoxib, and lumiracoxib were associated with increased risk of heart attack
- All 7 NSAIDs were associated with increased risk of the triad of non-fatal heart attack, non-fatal stroke, and cardiovascular death, compared to placebo
- All 7 NSAIDs were associated with increased risk of death by any cause, compared to placebo
- All NSAIDs except naproxen showed evidence of increased risk of cardiovascular death
- All 7 NSAIDs were associated with increased risk of stroke
- The drug manufacturer Merck declined to provide unpublished safety data on its drugs, rofecoxib and etoricoxib
- Nonspecific NSAIDs are no more safe than the "new generation NSAIDs", i.e. selective COX-2 inhibitors, which have previously become known for cardiovascular risk
- All NSAIDs, even those not included in the meta-analysis, have been observed to increase risk of cardiovascular adverse effects
This meta-analysis strongly cautions us to consider whether the cardiovascular risk of NSAIDs outweighs their clinical benefit in chronic musculoskeletal pain management.
