(HealthDay News) – The nonsteroidal anti-inflammatory drug (NSAID) diclofenac is associated with significantly increased vascular risk, comparable to that of selective COX-2 inhibitors (coxibs), according to a meta-analysis published online May 30 in The Lancet.
Colin Baigent, MD, from the University of Oxford in the United Kingdom, along with colleagues from the Coxib and traditional NSAID Trialists’ Collaboration, conducted a meta-analysis of 280 trials of NSAIDs vs. placebo involving 124,513 participants and 474 trials comparing different NSAIDs (involving 229,296 participants) to characterize the vascular and gastrointestinal effects of coxibs and NSAIDs.
The researchers observed a significant increase in the risk of major vascular events with a coxib (rate ratio [RR], 1.37) or diclofenac (RR, 1.41), mainly due to an increase in major coronary events (RR, 1.76 and 1.7, respectively). Ibuprofen correlated with a significant increase in the risk of major coronary events (RR, 2.22), but not major vascular events. For every 1,000 patients allocated to a coxib or diclofenac vs. placebo for one year, three more had major vascular events, one of which was fatal. Naproxen was not associated with an increase in major vascular events or vascular death. The risk of vascular death was significantly increased by coxibs and diclofenac (RR, 1.58 and 1.65, respectively) and increased non-significantly by ibuprofen. The risk of heart failure was approximately doubled with all NSAIDs, and upper gastrointestinal complications were increased with all NSAID regimens.
“The vascular risks of high-dose diclofenac, and possibly ibuprofen, are comparable to coxibs, whereas high-dose naproxen is associated with less vascular risk than other NSAIDs,” the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.