NSAIDs and Cardiovascular Risk

摘要

[...] nonselective NSAIDs with high COX-2 inhibition (e.g., diclofenac [Cataflam]) seem to have higher cardiovascular risk, whereas nonselective NSAIDs with high COX-1 inhibition (e.g., naproxen [Naprosyn], aspirin, ibuprofen) seem to have higher gastrointestinal risk.1 The primary focus of discussions on cardiovascular risk has been on thrombotic risk. [...] international guidelines have advocated caution when using NSAIDs in persons with heart failure.11 Furthermore, NSAIDs have been shown to influence renal function by decreasing renal perfusion and glomerular filtration rate; cause interstitial nephritis; increase blood pressure; and, in persons with preexisting hypertenion, destabilize blood pressure control.12 Several studies have demonstrated that, in persons with established cardiovascular disease or increased cardiovascular risk, NSAIDs are even more harmful with regards to cardiovascular adverse events.7-9,13 Although current evidence points to increased cardiovascular risk with NSAIDs, a total abandonment of NSAID use is not likely or possible.