Areas of emerging interest in analgesia: cardiovascular complications.
Many people obtain symptomatic relief from acute, chronic, or recurring pain conditions by using an over-the-counter analgesic. As with the use of any drug, this involves achieving the appropriate balance between potential benefit and risk of harm. The adverse effects of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) in the gastrointestinal (GI) tract are widely appreciated. On the basis of their pharmacology, however, these drugs also have the potential for causing adverse effects in the cardiovascular system. This is particularly the case in certain overlapping populations (eg, the elderly or those with cardiac failure, hypertension, or renal impairment). And the size of the exposed populations and the fact they comprise people likely to require pain management because of concomitant illnesses make the cardiovascular implications of analgesic use potentially a more serious issue for public health than the more widely recognized GI complications of aspirin and NSAID use. This article discusses the impact on the cardiovascular system of different classes of analgesics (NSAIDs, the new cyclooxygenase-2-selective inhibitors [CSIs], and paracetamol) in terms of cardiac function, thrombotic and cardioprotective potential, and hypertension. It identifies patients at risk for analgesic-related cardiovascular adverse events, and considers their options for managing mild-to-moderate pain. Unlike that of the NSAIDs and CSIs, the pharmacology of paracetamol provides no signal for risk of cardiovascular adverse events, and paracetamol should, therefore, be considered as first-line therapy in patients with cardiovascular disease.
Hillis
W Stewart
WS
University of Glasgow, Western Infirmary, Dumbarton Road, Glasgow, Scotland, United Kingdom. w.s.hillis@clinmed.gla.ac.uk
D000082:Acetaminophen / Q000009:adverse effects; D000368:Aged; D000700:Analgesics / Q000009:adverse effects* / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000188:drug therapy* / Q000517:prevention & control; D015897:Comorbidity; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects; D004198:Disease Susceptibility; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006266:Health Education; D006323:Heart Arrest / Q000139:chemically induced; D006801:Humans; D004366:Nonprescription Drugs / Q000009:adverse effects* / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy*; D010353:Patient Education as Topic; D012307:Risk Factors
D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D004366:Nonprescription Drugs; D000082:Acetaminophen