title: Cardiovascular adverse events by non-steroidal anti-inflammatory drugs: when the benefits outweigh the risks.
abstract: Therapeutic efficiency of NSAID is handicapped by ongoing discussion of cardiovascular (CV) safety. Areas covered: We update meta-analyses on NSAIDs in patients with and without cardiovascular (CV) diseases and analyse the association between NSAIDs and cardiovascular events in patients with inflammation. We demonstrate the substantial influence of an indication bias and confounding, which falsely increase the CV risk. We demonstrate protective cardiovascular effects of NSAIDs due to their anti-inflammatory activity, in particular in patients with rheumatoid arthritis, osteoarthritis or inflammatory pain. Expert commentary: t-NSAIDs and Coxibes drugs resemble in their observed CV risk which, in contrast, reflects the intrinsic risk of patients with pain and inflammation. The anti-inflammatory NSAIDs reduce the risk of first myocardial infarction in patients with inflammation and elevated CRP. The extended use of NSAIDs is not associated with an increased CV risk in patients with pain and inflammation but with reduction in all-cause mortality.
authors: a Medical Department , Former employee of MSD Sharp & Dohme GmbH , Munich , Germany.
authors: Gerhard
authors: G
authors: Zingler
authors: b Practical Orthopedist (Private Practice) , Hamburg , Germany.
authors: Birgit
authors: B
authors: Hermann
authors: c Medical Department , Employee of MSD Sharp & Dohme GmbH , Munich , Germnany.
authors: Tim
authors: T
authors: Fischer
authors: d Institute of Experimental and Clinical Pharmacology , University Hospital Schleswig-Holstein , Kiel , Germany.
authors: Thomas
authors: T
authors: Herdegen
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D015982:Bias; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D015986:Confounding Factors, Epidemiologic; D006801:Humans; D007249:Inflammation / Q000188:drug therapy*; D010003:Osteoarthritis / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Adverse side effects; analgesics; cardiovascular events; cyclooxygenase; diclofenac; etoricoxib; ibuprofen; meta-analysis; non-steroidal-anti-inflammatory drugs; osteoarthritis; rheumatoid arthritis