Cardiovascular Risk Compared Among COX-2 Selective, Nonselective NSAIDs

A total of 55,629 patients were assessed; 2,749 who initiated COX-2 selective NSAIDs and 52,880 initiated nonselective NSAIDs
A total of 55,629 patients were assessed; 2,749 who initiated COX-2 selective NSAIDs and 52,880 initiated nonselective NSAIDs

A study published in the British Journal of Clinical Pharmacology provides new insight into the cardiovascular safety profiles of nonsteroidal anti-inflammatory drugs (NSAIDs).

To investigate the comparative cardiovascular safety of these agents, researchers conducted a cohort study using a population-based Taiwanese database. A total of 55,629 patients with hypertension were identified; 2,749 initiated treatment with cyclooxygenase-2 enzyme (COX-2) selective NSAIDs (celecoxib: 65% and etoricoxib: 35%) and 52,880 initiated nonselective NSAIDs (diclofenac: 34%, mefenamic acid: 22%, and ibuprofen: 15%). Mean daily dose for each NSAID was as follows: celecoxib 210mg, etoricoxib 60mg, diclofenac 107mg, ibuprofen 1,084mg, naproxen 694mg, and mefenamic acid 1,248mg. Patients were followed for up to 4 weeks; outcomes of interest included major cardiovascular events such as acute myocardial infarction and hospitalization for ischemic stroke.

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The results showed that after adjusting for both baseline and time-varying covariates, the adjusted hazard ratio (HR) of major cardiovascular events comparing COX-2 selective NSAIDs to nonselective NSAIDs was 1.07 (95% CI, 0.65-1.74). When comparing COX-2 selective NSAIDs to other individual NSAIDs the adjusted HR was 0.91 (95% CI, 0.51-1.63) versus diclofenac, 1.22 (95% CI, 0.58-2.57) versus ibuprofen, and 0.67 (95% CI, 0.24-1.91) versus naproxen. Significant increased risk was observed, however, when celecoxib was compared to mefenamic acid (adjusted HR 2.11; 95% CI, 1.09-4.09).

"Our results provide important information about the comparative safety of alternative NSAID use in patients with hypertension in real-world settings," said co-author Dr. Chia-Hsuin Chang, of the National Taiwan University Hospital. "Under low-to-moderate daily dose and a short-term treatment period, most commonly used NSAIDs have similar cardiovascular safety profiles," 

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