Nonsteroidal Anti-Inflammatory Drugs And The Heart: What Is The Danger?

Main Category: Cardiovascular / Cardiology
Also Included In: Clinical Trials / Drug Trials;  Heart Disease
Article Date: 26 Jun 2008 - 2:00 PST


Available both over the counter and by prescription, nonsteroidal anti-inflammatory drugs (such as ibuprophen and naproxen) are commonly found in medicine cabinets and have been available for many years. Yet these medications may be associated with 103,000 hospitalizations and 16,500 deaths per year in the United States as the result of gastrointestinal adverse events, such as bleeding.

Studies indicate that other anti-inflammatories, coxibs, as well as NSAIDs, may pose a risk for blood clots leading to heart attack and/or stroke. As physicians and patients weight the benefits and risks, an ongoing study may help provide some answers.

In the journal Congestive Heart Failure, University of Kentucky cardiologist and College of Medicine special faculty member Debabrata Mukherjee notes:

"The ongoing Prospective Randomized Evaluation of Celecoxib Integrated Safety vs Ibuprofen or Naproxen (PRECISION) trial will assess the relative cardiovascular safety of 3 of the most commonly used pain relievers in the treatment of arthritis patients: ibuprofen, naproxen, and celecoxib. The study will primarily enroll patients with osteoarthritis, the most common form of arthritis, who have known coronary heart disease or who have multiple risk factors for heart disease and also some patients with rheumatoid arthritis. Patients will be followed for an average of 18 months to track the occurrence of serious cardiovascular events.

The PRECISION trial will compare celecoxib, the least selective coxib, with ibuprofen, which has a similar selectivity, and with the nonselective naproxen. The trial is therefore less likely to be associated with increased cardiovascular risk for the patients compared with the risk associated with more selective coxibs. Furthermore, use of low-dose aspirin, which might have an interaction with the ibuprofen, will be permitted in the study. Nevertheless, this study should provide some definitive evidence of the relative cardiovascular safety of the available anti-inflammatory agents."

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