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Use of Non-Steroidal Anti-Inflammatory Drugs That Elevate Cardiovascular Risk:
An Examination of Sales and Essential Medicines Lists in Low-, Middle-, and High-Income Countries

Source - plosmedecine.org [Texte complet]

Toxicité cardiovasculaire des AINS
Cette étude confirme que le naproxène est l'un des plus sûrs.

Liste des AINS devrait tenir compte du risque cardiovasculaire, avec une préférence pour les médicaments à faible risque. Le diclofénac est un risque très similaire à rofécoxib, qui a été retiré du marché à travers le monde en raison de la toxicité cardiovasculaire. Pour les auteurs, Le diclofénac doit être retiré de la liste des médicaments essentiels (LME).
En revanche, le naproxène, l'un des plus sûrs en termes relatifs, des AINS étudiés, a été parmi les moins populaires et a été inscrit sur une minorité de listes des médicaments essentiels (LME)

Revoir : Review Confirms CVD Risk With NSAIDS Rofecoxib, Diclofenac Naproxen appeared to have a neutral risk [Lire] (2011)

Background
Certain non-steroidal anti-inflammatory drugs (NSAIDs) (e.g., rofecoxib [Vioxx]) increase the risk of heart attack and stroke and should be avoided in patients at high risk of cardiovascular events. Rates of cardiovascular disease are high and rising in many low- and middle-income countries. We studied the extent to which evidence on cardiovascular risk with NSAIDs has translated into guidance and sales in 15 countries.

Methods and Findings
Data on the relative risk (RR) of cardiovascular events with individual NSAIDs were derived from meta-analyses of randomised trials and controlled observational studies. Listing of individual NSAIDs on Essential Medicines Lists (EMLs) was obtained from the World Health Organization. NSAID sales or prescription data for 15 low-, middle-, and high-income countries were obtained from Intercontinental Medical Statistics Health (IMS Health) or national prescription pricing audit (in the case of England and Canada). Three drugs (rofecoxib, diclofenac, etoricoxib) ranked consistently highest in terms of cardiovascular risk compared with nonuse. Naproxen was associated with a low risk. Diclofenac was listed on 74 national EMLs, naproxen on just 27. Rofecoxib use was not documented in any country. Diclofenac and etoricoxib accounted for one-third of total NSAID usage across the 15 countries (median 33.2%, range 14.7–58.7%). This proportion did not vary between low- and high-income countries. Diclofenac was by far the most commonly used NSAID, with a market share close to that of the next three most popular drugs combined. Naproxen had an average market share of less than 10%.

Conclusions
Listing of NSAIDs on national EMLs should take account of cardiovascular risk, with preference given to low risk drugs. Diclofenac has a risk very similar to rofecoxib, which was withdrawn from worldwide markets owing to cardiovascular toxicity. Diclofenac should be removed from EMLs.

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