NSAIDs are associated with significant increases in death and cardiovascular morbidity, according to a large, new registry study from Denmark in the Archives of Internal Medicine (2009;169(2):141-149).
Danish researchers found dose-dependent elevated risk levels for death and risk of hospitalization with use of rofecoxib, celecoxib, ibuprofen, diclofenac, naproxen, and other NSAIDs. They conclude that “patients with HF should, if possible, avoid using any NSAIDs at any dosage for most NSAIDS and at high dosages for ibuprofen and naproxen.”
Dr. Steven Nissen agrees with the recommendation of the researchers but fully acknowledges the limitations of this type of research. He told CardioBrief:
“Like all observational studies, this one has important weaknesses. There are many known and unknown confounders for which adjustment is not possible. All NSAIDs increase sodium retention and these drugs have long been associated with increased risk of heart failure. With regard to the effects on MI and mortality, the results suggest a class effect, but this can only be verified by a well-designed, prospective randomized trial. We are conducting such as study, the PRECISION trial in 20,000 patients using three of these drugs, naproxen, ibuprofen, and celecoxib. Until the results are available, prudent practitioners should use NSAIDs in high risk patients only when absolutely necessary and should always use the lowest effective dosage for the least duration possible.”