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High-dose NSAIDs raise cardiovascular risk

By Christian Duffin

A wide range of NSAIDs can increase the risk of heart attacks and strokes when prescribed at high doses, Swiss and German researchers say.

The analysis included 31 trials of 116,429 patients taking seven different drugs – naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib, lumiracoxib or placebo.

Compared with placebo, rofecoxib was associated with the highest risk of myocardial infarction, with a rate ratio of 2.12, followed by lumiracoxib with a rate ration of 2.00.

Ibuprofen was associated with the highest risk of stroke, with a rate ratio of 3.36 compared with placebo, followed by diclofenac at 2.86. Etoricoxib (with a rate ratio of 4.07) and diclofenac (3.98) were associated with the highest risk of cardiovascular death.

But study leader Professor Peter Jüni, professor of clinical epidemiology at the University of Bern in Switzerland, acknowledged: ‘Some may argue the absolute rates of cardiovascular events are low and clinically irrelevant, despite increases in rate ratios.'

BMJ, published online 11 January 2011

High-dose NSAIDs raise CV risk

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