Comparative cardiovascular safety of traditional nonsteroidal anti-inflammatory drugs

Détails

ID Serval
serval:BIB_CF24F7E57D71
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Institution
Titre
Comparative cardiovascular safety of traditional nonsteroidal anti-inflammatory drugs
Périodique
Expert Opinion on Drug Safety
Auteur⸱e⸱s
Maillard  M., Burnier  M.
ISSN
1744-764X (Electronic)
Statut éditorial
Publié
Date de publication
01/2006
Volume
5
Numéro
1
Pages
83-94
Notes
Journal Article
Review --- Old month value: Jan
Résumé
Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for their anti-inflammatory and analgesic effects. Unfortunately, these drugs are not without toxicity, namely on the gastric mucosa, but also on the cardiovascular system. In this context, the marketing of the coxibs, a new series of NSAIDs that selectively inhibit COX-2, resulted in a large debate around their cardiovascular safety, because they may increase the incidence of myocardial infarction and stroke. The recent suspension of a large, randomised, controlled trial comparing celecoxib, naproxen and placebo in Alzheimer patients (the ADAPT trial) because of an apparent elevated cardiovascular risk in the naproxen group revived the debate on the cardiovascular safety of these drugs, but this time with special emphasis on the effect of traditional nonselective NSAIDs (tNSAIDs). In this paper that reviews and discusses the cardiovascular safety profile of tNSAIDs, essentially naproxen and ibuprofen in view of the most recent experimental and clinical data, the authors note that the published data are quite discordant and one cannot conclude that there is clear evidence to support a cardiovascular hazard from the administration of naproxen or non-naproxen NSAIDs unless additional information is provided. In addition, the results of retrospective case-control studies have to be interpreted very carefully because of the risk of confounding factors that are not always taken into account when subjects were classified either as cases or controls. Thus, in the absence of clear cut data, physicians will have to use traditional NSAIDs (or coxibs) in patients with a high cardiovascular risk on the basis of their common sense rather than on evidence-based medicine. For these patients, one should not forget that an inadequate long-term control of cardiovascular risk factors such as a hypertension, dyslipidaemia, diabetes, smoking and weight excess is more deleterious in terms of cardiovascular mortality than the administration of NSAIDs itself.
Mots-clé
Anti-Inflammatory Agents, Non-Steroidal/*adverse effects/*therapeutic use Blood Platelets/drug effects/physiology Blood Pressure/drug effects Cardiovascular Diseases/*chemically induced Cyclooxygenase Inhibitors/adverse effects/therapeutic use Humans Kidney/drug effects/physiology Risk Factors
Pubmed
Web of science
Création de la notice
25/01/2008 13:59
Dernière modification de la notice
20/08/2019 16:49
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