Cardiovascular risk of anti-inflammatories


In the last number of months the debate has intensified about the cardiovascular risks of anti-inflammatories such as aspirin, ibuprofen or paracetamol, which are among the best known of these drugs (NSAIDs: traditional nonspecific non-steriodal anti-inflammatory drugs and COX-2: selective inhibitors of cyclo-oxygenase-2).

Some recent publications have shed some light on this issue by way of different studies that have carried out research on the cardiovascular risks, and other types of risks in the administration of both types of anti-inflammatories.

Several studies that allow conclusions to be drawn

The Finnish group, Helin-Salmivaara et al., kept track of more than 33,000 patients diagnosed with first myocardial infarction to test their association with the administration of these two types of anti-inflammatories.

The results show that, although there was a moderate increase in the risk of first myocardial infarction with the use of either of these compounds, the risk was similar in both types of anti-inflammatories. Another recent study by Anderssohn et al., assessed the risk of ischaemic stroke in those of type COX-2 and concluded that this risk depends only on the individual properties of the active ingredients and not on the family of drugs to which they belong.

Comparing both types of anti-inflammatories(COX-2 and traditional NSAIDs)

Take for instance the case of Celecoxib, of the COX-2 group. It is a drug that had a different type of reaction from that of other members of the same family, showing no association between administration and increased incidences of strokes.

In this regard, the study published by Varas-Lorenzo et al., performed on 100,000 patients per year, showed that administration of this anti-inflammatory drug does not increase the risk of cardiovascular complications or mortality when compared individually with traditional NSAIDs such as ibuprofen.

In addition, Celecoxib reduced the number of ulcer complications and associated mortality in these types of problems when compared with each of these separately tested NSAIDs.

The answer may lie in possible excesses in the dose of selective inhibitors

The more recent MEDAL study also shows no increase in cardiovascular mortality when comparing COX-2 with diclofenac, of the NSAID group.

Along these lines, further studies suggest that the increased cardiovascular risk may be dose-dependent; in other words, it is not presented with recommended doses, but may appear with the administration of excessive doses.

Let the data speak and the specialists decide

We must be cautious and rigorous when we talk about drugs and their potential risks. If the information of this kind of study is not filtered by experts, unjustified alerts which might come to the attention of public opinion may be generated.

When making clinical decisions, the scientific evidence must prevail against disproportionate alarms. In any case, it is the responsibility of rheumatologists, who are the specialists in this field, to decide on which inflammatory is to be administered after evaluating the potential cardiovascular and gastrointestinal risk of each patient on an individual basis.

When the cardiovascular risk is low or intermediate, there is no problem in prescribing an NSAID or Coxib, but if the risk is high, the prescription and administration of these anti-inflammatories should be used with caution and under tight clinical monitoring.