High dose NSAIDs may double the risk of heart attacks and heart failure, says new study

BMJ 2013; 346 doi: (Published 30 May 2013) Cite this as: BMJ 2013;346:f3533
  1. Krishna Chinthapalli
  1. 1BMJ

High doses of commonly used non-steroidal anti-inflammatory drugs (NSAIDs) could double the risk of myocardial infarction and heart failure, according to a new study published in the Lancet.1

Daily treatment with cyclo-oxygenase 2 (COX 2) inhibitors, such as celecoxib and etoricoxib, or high dose daily regimens of ibuprofen (2400 mg), diclofenac (150 mg), and naproxen (1000 mg) were analysed for cardiovascular and gastrointestinal side effects.

In a series of meta-analyses of over 600 randomised trials with over 350 000 participants (mean age 61 years), the authors found that all NSAIDs doubled the risk of heart failure (rate ratio 1.85-2.28). Compared with placebo, a COX 2 inhibitor or diclofenac caused three additional major vascular events per 1000 participants per year (from a baseline risk of eight events per 1000 participants per year), with one such event causing death. A major vascular event was defined …

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