Review Confirms CVD Risk With NSAIDS Rofecoxib, Diclofenac
Naproxen appeared to have a neutral risk
McGettigan P, Henry D. Cardiovascular risk with nonsteroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies.
PLoS Med 2011;
That study, reported by heartwire , showed that cardiovascular risk was increased with diclofenac, indomethacin, and meloxicam as well as with rofecoxib. Naproxen was not cardioprotective, as had been previously suggested, but appeared to have a neutral risk, and results with ibuprofen were inconclusive.
Naproxen was consistently shown to be safe, even at high doses, suggesting it should be the NSAID of choice in patients with increased cardiovascular risk. Naproxen was shown to be safer than ibuprofen, with the risk of cardiovascular events increasing with ibuprofen at daily doses ranging from 1200 mg to 1600 mg.
If ibuprofen is used in high-risk patients, Henry said the dose should be kept low, but if a higher dose is needed, clinicians should switch to naproxen. Of the three NSAIDs available over the counter, ibuprofen and naproxen were safe at low doses, while diclofenac was associated with a 22% increase in risk at low doses.
Drugs and Pooled Relative Risks of Cardiovascular Events