Nonsteroidal anti-inflammatory drugs (NSAIDs), both older traditional versions and the newer generation known as COX-2 inhibitors, have been major players in the treatment of osteoarthritis and other types of arthritis for many years. You may recall though, in 2004, Vioxx (rofecoxib) was withdrawn from the market after the drug was linked to an increased risk of cardiovascular disease. The safety of NSAIDs and COX-2 inhibitors has been the subject of debate ever since -- a debate that studies have not yet resolved. Have you wondered how serious the risk is -- or with all the NSAIDs to choose from, which might have the least risk? I've wondered myself, since I have taken one or the other of these drugs for 36-plus years.
According to a report published January 11, 2011 in the British Medical Journal, researchers in Switzerland conducted an analysis of all randomized, controlled trials that compared any NSAID with other NSAIDs or placebo. Their analysis included 31 trials, involving 116,429 patients, 7 different drugs -- including naproxen, ibuprofen, diclofenac, celecoxib (Celebrex) , etoricoxib (Arcoxia), rofecoxib (Vioxx), and lumiracoxib (Prexige) -- and placebo. In 29 of the trials, there were 554 heart attacks. In 26 trials, there were 377 strokes -- and in 28 trials, there were 676 deaths. Researchers concluded from the analysis that the absolute risk of cardiovascular events was low among patients taking these drugs -- but relative to placebo, the risk was significant.
Compared to placebo:
- Vioxx and Prexige carried twice the risk of heart attack.
- Ibuprofen exhibited more than 3 times the risk of stroke.
- Arcoxia and diclofenac had the highest risk of cardiovascular death (about 4 times that of placebo).
Of the 7 drugs in the analysis, researchers pegged naproxen as the one with the least cardiovascular risk. Although absolute risk was low in the analysis, researchers feel it is a mistake to overlook cardiovascular risk when NSAIDs are prescribed. This is a problem -- NSAIDs are commonly used painkillers and many patients who take them for arthritis also have heart disease.
- NSAIDs - 10 Things You Need to Know
- Cyclooxygenase - COX-1 and COX-2 Explained
- Celebrex (celecoxib) - What You Need to Know
- Naproxen - What You Need to Know
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