NSAID Cardio Risk for Healthy People Varies by Drug

Diclofenac and rofecoxib linked to higher cardiovascular risk; naproxen has safer risk profile
By Jeff Muise
HealthDay Reporter

WEDNESDAY, June 9 (HealthDay News) -- Use of the nonsteroidal anti-inflammatory drugs (NSAIDs) diclofenac and rofecoxib by healthy people is associated with an increased risk of cardiovascular death, but naproxen appears to have a safer cardiovascular risk profile, according to a study published online June 8 in Circulation: Cardiovascular Quality and Outcomes.

Emil Loldrup Fosbøl, of Gentofte University Hospital in Hellerup, Denmark, and colleagues extracted data from nationwide registers on 1,028,437 healthy Danish subjects who had not been hospitalized for at least five years previous to their first NSAID prescription claim, and who had not claimed drug prescriptions for certain concomitant medications two years previously. The researchers assessed the risks for cardiovascular death, a composite of coronary death or nonfatal myocardial infarction, and fatal or nonfatal stroke linked to NSAID use.

The investigators discovered that use of either diclofenac or rofecoxib was associated with an increased risk of cardiovascular death (odds ratios [ORs], 1.91 and 1.66, respectively), with risk increasing for higher doses. Use of naproxen was not associated with increased risk for cardiovascular death (OR, 0.84). Ibuprofen use was associated with a trend toward increased risk of stroke -- either fatal or nonfatal (OR, 1.29).

"Individual NSAIDs have different degrees of cardiovascular safety, which must be considered when choosing appropriate treatment. In particular, rofecoxib and diclofenac were associated with increased cardiovascular mortality and morbidity and should be used with caution in most individuals, whereas our results suggest that naproxen has a safer cardiovascular risk-profile," the authors write.

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