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Cardiovascular Risk Among Individual Pain Medicines: Is There a Difference?

February 21, 2018
Recent study differentiates risk among individual NSAIDs

A PPM Brief

While studies have suggested that non-steroidal anti-inflammatory drugs (NSAIDs) may be associated with higher cardiovascular risks and adverse outcomes, no study seems to have directly assessed potential differential cardiovascular risk between classes or across individual NSAIDs, until now. A new report in the British Journal of Clinical Pharmacology1 compares the risk of major cardiovascular events between cyclooxygenase-2 enzyme (COX-2) selective NSAIDs and nonselective NSAIDs in patients with hypertension.

In this longitudinal, population-based cohort study, authors examined the cardiovascular safety of NSAIDs in patients with hypertension by using inverse probability weighting to account for both baseline and time-varying covariates. There was no strong evidence to suggest a higher cardiovascular risk with COX-2 selective NSAIDs (celecoxib and etoricoxib) or celecoxib alone compared to diclofenac, ibuprofen, and naproxen. However, an elevated risk when comparing celecoxib to mefenamic acid was noted.1

Specifically, the study identified 2,749 eligible COX-2 selective NSAID users and 52,880 eligible nonselective NSAID users. The hazard ratios (HR) of major cardiovascular events comparing COX-2 selective NSAIDs to nonselective NSAIDs after adjusting for baseline and time-varying covariates was 1.07 (95% confidence interval (CI), 0.65-1.74). As mentioned, the study did not observe a differential risk when comparing celecoxib to diclofenac (HR, 1.17; 95% CI, 0.61-2.25), ibuprofen (HR, 1.36; 95% CI, 0.58-3.18), or naproxen (HR, 0.75; 95% CI, 0.23-2.44). However, there was an increased risk with COX-2 selective NSAIDs when comparing COX-2 to mefenamic acid (HR, 2.11; 95% CI, 1.09-4.09).1

“As hypertension is a prevalent condition and a major risk factor for cardiovascular diseases,” the study authors wrote, “our results provide important information about the comparative safety of alternative NSAID use and suggest that most commonly used NSAIDs have similar cardiovascular safety profiles in this vulnerable population.”

Results of the study provide important information about the comparative safety of alternative NSAID use in patients with hypertension in real-world settings. The findings suggest that, under low-to-moderate daily dose and a short-term treatment period, most commonly used NSAIDs, including celecoxib, diclofenac, ibuprofen, and naproxen, have similar cardiovascular safety profiles.1

“Our results also suggest that the relation between NSAIDs and cardiovascular risk is complex and might be more appropriate to describe NSAID-associated cardiovascular safety by individual drug rather than as a whole drug class,” study authors said.

Last updated on: February 23, 2018
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