Bhala N, Emberson J, Merhi A, et al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013;382:769-79.
What are the vascular and gastrointestinal effects of non-steroidal anti-inflammatory drugs (NSAIDs)?
NSAIDs reduce pain, fever, and inflammation. Traditional NSAIDs include aspirin, ibuprofen, and naproxen.
Selective COX-2 inhibitors (coxibs) are a newer type of NSAID that target the COX-2 inflammatory protein.
The long-term use of NSAIDs is limited by serious gastrointestinal (GI) side effects.
This summary is based on a meta-analysis of 754 randomized controlled trials that included 353,809 people. 280 trials (124,513 people) compared NSAIDs with placebo, and 474 trials (229,296 people) compared 2 different NSAIDs. The publication period was 1990 to 2011.
In studies providing individual participant data, the average age at start of treatment was 61 years.
NSAIDs included were coxibs, diclofenac, ibuprofen, and naproxen.
Outcomes included major vascular events (non-fatal heart attack, non-fatal stroke, or vascular death); major coronary events (non-fatal heart attack or heart problems); heart failure; and gastrointestinal complications (perforation, obstruction, or bleed).
As shown in the Table below, compared with placebo,
Non-steroidal anti-inflammatory drugs (NSAIDs), except for naproxen, increase major coronary events.
All NSAIDs increase heart failure and upper gastrointestinal complications more than placebo. The absolute increase in risk is small, but the complications can be serious.
Relative increase with NSAIDs compared with placebo or no treatment
|NSAIDs||Vascular events||Coronary events||Heart failure||Vascular death||GI complications|
|Coxibs||37% increase||76% increase||128% increase||58% increase||81% increase|
|Diclofenac||41% increase||70% increase||85% increase||65% increase||89% increase|
|Ibuprofen||No increase||122% increase||149% increase||No increase||97% increase|
|Naproxen||No increase||No increase||87% increase||No increase||322% increase|
This Evidence Summary was originally prepared for the McMaster Optimal Aging Portal.
Published: Monday, August 14, 2017