Cardiovascular safety of non-aspirin non-steroidal anti-inflammatory drugs: review and position paper by the working group for Cardiovascular Pharmacotherapy of the European Society of Cardiology
Why the study?
Given current uncertainty regarding the safety of non-aspirin NSAIDs and rapidly accumulating data on their cardiovascular risks, there was a need to summarize evidence from randomized and observational studies and present a position on their use.
Do non-aspirin NSAIDs increase the risk of cardiovascular complications?
Design
Review and position paper
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The problem, as expected, is that these drugs are sold over-the-counter without any advice on side effects or the harmful effects. And even though they are sold in low dosages, the message is wrong. If you have an average individual, somebody who doesn't have this knowledge [about the risks], they're trusting the healthcare authorities or regulators that the drugs are safe to use. That's the problem. It gives a misconception that the drugs are safe.”
Implication
Clinicians should limit coxibs and diclofenac in CV-risk patients; reinforces RCT and observational evidence of harm.
Key Points
- The review aims to evaluate the cardiovascular safety of non-aspirin NSAIDs and provide a position on their clinical use.
- Summarized evidence from randomized and observational studies
- Analyzed the cardiovascular risks associated with non-aspirin NSAIDs and COX-2 inhibitors
- Assessed usage patterns and indications for these medications
- Coxibs like rofecoxib and celecoxib show increased cardiovascular risk; therefore, their indications are limited.
- Diclofenac, an older COX-2 inhibitor, retains high global usage despite risk concerns.
- Mixed COX-1/COX-2 inhibitors such as ibuprofen and naproxen lack conclusive safety evidence, raising uncertainties.
Structured PICO
Do non-aspirin NSAIDs increase the risk of cardiovascular complications?
P
Population
Patients using non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs)
I
Intervention
Non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs), including selective COX-2 inhibitors and mixed COX-1/COX-2 inhibitors
O
Outcome
Cardiovascular safety and complicationssafety
This position paper by the European Society of Cardiology highlights the significant cardiovascular risks associated with both selective COX-2 inhibitors and traditional non-aspirin NSAIDs.
Cite This Study
Schmidt et al. (2016) conducted a review in Cardiovascular risk associated with NSAID use. Non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) was evaluated. This review summarizes evidence on the cardiovascular safety of non-aspirin NSAIDs, highlighting that selective COX-2 inhibitors and diclofenac increase the risk of cardiovascular complications.