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(Circulation. 2007;115:1634-1642.)
© 2007 American Heart Association, Inc.

AHA Scientific Statements

Use of Nonsteroidal Antiinflammatory Drugs

An Update for Clinicians: A Scientific Statement From the American Heart Association

Elliott M. Antman, MD, FAHA; Joel S. Bennett, MD; Alan Daugherty, PhD, FAHA; Curt Furberg, MD, PhD, FAHA; Harold Roberts, MD, FAHA; Kathryn A. Taubert, PhD, FAHA

Key Words: AHA Scientific Statements • aspirin • inhibitors • drugs • antiinflammatory agents, nonsteroidal • coxibs • cyclooxygenase 2 inhibitors

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Clinical trial data have prompted questions about the degree to which patients and their physicians should consider an increased risk of cardiovascular or cerebrovascular events when selecting medications for pain relief. Since the 2005 publication of a Science Advisory on the use of nonsteroidal antiinflammatory drugs (NSAIDs) by the American Heart Association,¹ several important events have occurred that have served as the catalyst for this update for clinicians. (1) Additional data from randomized controlled trials of cyclooxygenase (COX)-2–selective agents have been reported and summarized in meta-analyses, which has reinforced the concern about cardiovascular events with COX-2 inhibitors (coxibs; Figure 1). (2) Several reports have appeared that have identified an increased risk of cardiovascular events even with the nonselective NSAIDs, which has raised concern about the use of those agents as well (Table). (3) Regulatory authorities in several regions of the world have introduced warning statements and advisories to both healthcare professionals and the lay public about the use of various NSAIDs (Figures 2 and 3).

View larger version (22K):   Figure 1. Comparison of effects of different selective COX-2 inhibitors vs placebo on myocardial infarction. Event numbers and person-years of exposure, with corresponding mean annual event rates in parentheses, are presented for patients allocated to selective COX-2 inhibitor or placebo. Event rate ratios for pooled data with 95% CIs are indicated by a diamond; rate ratios for individual selective COX-2 inhibitors, with 99% CIs, are indicated by a square and horizontal line. Diamonds to the right of the solid line . . . [Full Text of this Article]

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