No NSAID may be safe in cardiovascular terms - naproxen seems least harmful

This BMJ meta-analysis included large scale randomised controlled trials comparing any non-steroidal anti-inflammatory drug (NSAID) with other non-steroidal anti-inflammatory drugs or placebo. Data synthesis included 31 trials in 116, 429 patients. Patients were allocated to naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib, lumiracoxib, or placebo.

Study outcomes

The primary outcome was myocardial infarction. Secondary outcomes included stroke, death from cardiovascular disease, and death from any cause.

Cardiovascular risks

Compared with placebo, rofecoxib (Vioxx) was associated with the highest risk of myocardial infarction (rate ratio 2.12), followed by lumiracoxib (2.00).

Ibuprofen was associated with the highest risk of stroke (3.36), followed by diclofenac (2.86).

Etoricoxib (4.07) and diclofenac (3.98) were associated with the highest risk of cardiovascular death.

Little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms. Naproxen (Aleve, Naprosyn) seemed least harmful.

According to the corresponding BMJ editorial, Celebrex (celecoxib) is not much safer either: "All cyclo-oxygenase-2 inhibitors studied in large placebo controlled trials have been found to confer an increased risk of serious cardiovascular disease. This suggests that patients with a high risk of cardiovascular disease should avoid cyclo-oxygenase-2 inhibitors (COX-2). "


Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ 2011; 342:c7086 doi: 10.1136/bmj.c7086 (Published 11 January 2011)

Editorial: Cardiovascular safety of NSAIDs. Wayne A Ray. BMJ 342:doi:10.1136/bmj.c6618 (Published 11 January 2011)

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