No difference in cardiovascular risk of selective and non-selective NSAIDs, study finds

Most commonly used non-steroidal anti-inflammatory drugs (NSAIDs) have similar cardiovascular safety profiles, when given as a low-to-moderate daily dose for a short-term treatment period, a new study has concluded^[1]
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Researchers carried out a cohort study of patients with hypertension who initiated cyclooxygenase (COX)-2 enzyme-selective NSAIDs (2,749) or non-selective NSAIDs (52,880) in a population-based Taiwanese database.

During four weeks of follow up, the researchers found no apparent difference in the cardiovascular risk for patients who were on the COX-2-selective NSAID treatment, celecoxib, versus patients who received non-selective NSAID treatments, such as diclofenac, ibuprofen and naproxen.

A significant increase in risk was observed when comparing celecoxib to mefenamic acid. However, the researchers highlighted that the latter is commonly used for dysmenorrhea and dental pain, rather than arthritis in clinical settings. Patients may tend to take the drug irregularly and it is therefore less likely to interfere with the COX system and more likely to present a lower cardiovascular risk than celecoxib.

“Our results provide important information about the comparative safety of alternative NSAID use in patients with hypertension in real-world settings,” said Chia-Hsuin Chang, co-author and clinical associate professor at the National Taiwan University Hospital.

“Under low-to-moderate daily dose and a short-term treatment period, most commonly used NSAIDs have similar cardiovascular safety profiles,” he added.