Cardiovascular adverse events by non-steroidal anti-inflammatory drugs: when the benefits outweigh the risks

ABSTRACT

Introduction: Therapeutic efficiency of NSAID is handicapped by ongoing discussion of cardiovascular (CV) safety.

Areas covered: We update meta-analyses on NSAIDs in patients with and without cardiovascular (CV) diseases and analyse the association between NSAIDs and cardiovascular events in patients with inflammation. We demonstrate the substantial influence of an indication bias and confounding, which falsely increase the CV risk. We demonstrate protective cardiovascular effects of NSAIDs due to their anti-inflammatory activity, in particular in patients with rheumatoid arthritis, osteoarthritis or inflammatory pain.

Expert commentary: t-NSAIDs and Coxibes drugs resemble in their observed CV risk which, in contrast, reflects the intrinsic risk of patients with pain and inflammation. The anti-inflammatory NSAIDs reduce the risk of first myocardial infarction in patients with inflammation and elevated CRP. The extended use of NSAIDs is not associated with an increased CV risk in patients with pain and inflammation but with reduction in all-cause mortality.

KEYWORDS:

• Adverse side effects
• analgesics
• cardiovascular events
• cyclooxygenase
• diclofenac
• etoricoxib
• ibuprofen
• meta-analysis
• non-steroidal-anti-inflammatory drugs
• osteoarthritis
• rheumatoid arthritis

Declaration of interest

G Zingler, a former employee and T Fischer, a present employee of the company MSD Sharp & Dohme GmbH, emphasize that interpretation and conclusions contained herein do not necessarily represent those of the company MSD Sharp & Dohme GmbH. All authors contributed substantially to the conception and design of the investigation as well as to the analysis and interpretation of data. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.