Cardiovascular Risk Associated With NSAIDs and COX-2 Inhibitors

Laura A. Perry, RPh, PharmD, BCPS; Charles Mosler, RPh, PharmD, CGP, FASCP; Ashton Atkins, PharmD; Megan Minehart, PharmD


US Pharmacist. 2014;39(3):35-38. 

In This Article

Abstract and Introduction


Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pain associated with a variety of medical conditions. Nonselective NSAIDs reversibly inhibit the enzyme cyclooxygenase (COX) in both of its isoforms, COX-1 and COX-2. An increased risk of cardiovascular events has been associated with the use of NSAIDs, especially of COX-2 selective NSAIDs. Current evidence suggests that naproxen, a nonselective NSAID, is associated with the lowest risk of cardiovascular events. Therefore, naproxen is the NSAID of choice in patients with high cardiovascular risk.


Cardiovascular disease is defined as any disease that involves the heart, blood vessels, or both, many of which are related to the process of atherosclerosis. Approximately 83 million American adults are affected by one or more types of cardiovascular disease, and of these patients, 40 million are 60 years of age or older.[1] Many patients of varying ages utilize OTC and prescription anti-inflammatory drugs to manage pain. Approximately 30 million Americans use nonsteroidal anti-inflammatory drugs (NSAIDs) daily for reasons ranging from cardioprotection and everyday aches and pains to more serious complications such as rheumatoid arthritis, acute gout, and other comorbid conditions.[2]

Patients at an increased risk for cardiovascular events with concurrent usage of NSAIDs include patients with recent bypass surgery, unstable angina, myocardial infarction (MI), ischemic cerebrovascular events, or any other active athlerosclerotic process. Patients who have cardiovascular disease and are taking NSAIDs, especially cyclooxygenase-2 (COX-2) selective agents, are at a much higher risk of having an MI than patients not taking these drugs. Therefore, understanding the potential danger of the use of NSAIDs in patients who have cardiovascular risk factors is essential.[1,3]