Cardiovascular safety of non-steroidal anti-inflammatory drugs revisited

Luigi Marzio Biasucci, Chris Walker

Risultato della ricerca: Contributo in rivistaArticolo in rivista

23 Citazioni (Scopus)

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) have been widely used to treat inflammatory pain for decades. More recently, newer NSAIDs were developed to target the inducible isoform of cyclooxygenase (COX), COX-2, with the aim of reducing gastrointestinal toxicity. While the COX-2 selective inhibitors were effective in reducing pain and gastrointestinal harm, they soon were associated with an increased risk of adverse cardiovascular events. Initially, the view emerged that selective inhibition of COX-2, and sparing of COX-1, was responsible for the increased cardiovascular harm observed. However, as more data from different human populations has become available this view has begun to be challenged. This review examines the current understanding of the role of prostaglandins and COX-1 and COX-2, particularly in platelets, the vasculature, and the kidney together with an overview of the cardiovascular and renal safety of both traditional NSAIDs and COX-2 selective inhibitors. Available data from active comparator randomized controlled trials, including the data from the PRECISION trial investigating the long term cardiovascular safety of patients exclusively with elevated baseline cardiovascular risk, are presented. The data, when considered holistically, support the idea that all NSAIDs carry some level of cardiovascular risk, be they traditional NSAIDs or COX-2 selective agents. There is also some evidence of heterogeneity of effect with NSAIDs particularly in relation to effects on blood pressure, with no clear demarcation based on the degree of COX-2 selectivity.
Lingua originaleEnglish
pagine (da-a)55-71
Numero di pagine17
RivistaPostgraduate Medicine
Volume130
DOI
Stato di pubblicazionePubblicato - 2018

Keywords

  • Anti-Inflammatory Agents, Non-Steroidal
  • COX-2
  • COX-2 selective inhibitors
  • Cardiovascular Diseases
  • Humans
  • Medicine (all)
  • Non-steroidal anti-inflammatory drugs
  • Prostaglandins
  • cardiovascular
  • osteoarthritis
  • renal

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