NSAIDs and the failing heart

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used drugs and are mainly used to alleviate pain and inflammation. NSAIDs were first introduced over a century ago and most of the commonly used NSAIDs were registered in an era with few requirements for safety documentation. Therefore, for most of these drugs, there is an alarming lack of randomised studies addressing their safety. With the introduction of selective cyclo-oxygenase (COX) 2 inhibitors, concerns were raised that unbalanced COX 2 inhibition might increase cardiovascular risk.1 This has been demonstrated in several randomised and observational studies, and further warning flags have been raised about the cardiovascular safety of non-selective NSAIDs.2 3 4 5 6 7

Arfé and colleagues8 present results from a nested case-control study based on real world data from four European countries and almost 10 million NSAID …