Non-Steroidal Anti-Inflammatory Drugs and Cardiovascular Risk (Clinical Practice)
Medications to relieve pain and inflammation are among the most commonly used drugs in our society today. The traditional non-selective non-steroidal anti-inflammatory drugs (NSAIDs) and the selective cyclooxygenase-2 (COX-2) inhibitors are effective anti-inflammatory and analgesic agents used in a wide range of acute and chronic medical conditions. The gastrointestinal adverse effects are well recognised. There is now strong evidence to suggest that both the traditional NSAIDs (excluding aspirin) and the COX-2 inhibitors are associated with an increased risk of thrombotic events (including myocardial infarction (MI) and stroke) and excess mortality both in patients with and without pre-existing cardiovascular disease. Although their benefits in terms of symptomatic relief when used appropriately are unquestioned, there is concern that the NSAIDs and COX-2 inhibitors are prescribed or recommended by doctors and pharmacists (many of these drugs are available without prescription) for trivial or inappropriate indications without due consideration regarding their potential adverse effects. The traditional NSAIDs, freely available in public sector facilities, are often requested by patients and perceived by doctors as a ‘cheap’ and convenient way to keep patients happy and terminate a consultation. Some practitioners seem unaware of the magnitude of the problem or of the number needed to treat to cause harm. Many patients receive these drugs before other pharmacological or non-pharmacological treatments have been attempted. This has led to over-prescribing of these agents, particularly in an elderly population, in whom associated cardiovascular disease is the leading cause of death.