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NSAIDs and serious cardiovascular disorders: especially cox-2 inhibitors and diclofenac

机译：NSAIDS和严重的心血管疾病：特别是COX-2抑制剂和双氯芬酸

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Nonsteroidal anti-inflammatory drugs (NSAIDs) used as analgesics expose patients to cardiovascular risks that can be predicted from their pharmacological properties. As of mid-2015, what is known about the cardiovascular harms of the NSAIDs of choice, ibuprofen and naproxen? Most of the data from comparative trials of NSAIDs concern cox-2 inhibitors, diclofenac, ibuprofen and naproxen. Few studies have addressed the serious cardiovascular effects of other NSAIDs. In 2013, a UK team published a large meta-analysis of hundreds of randomised trials comparing NSAIDs with placebo or one NSAID with another NSAID. Compared with placebo, a statistically significant increase in the risk of serious cardiovascular adverse effects was demonstrated with cox-2 inhibitors and with diclofenac (about +40%). This risk is mainly due to an increase in myocar-dial infarctions and vascular deaths. Another meta-analysis found similar results in terms of cardiovascular deaths.The results of epidemiological studies are consistent with those of randomised clinical trials. According to meta-analyses of randomised trials, high-dose ibuprofen increases cardiovascular risks to the same degree as diclofenac or cox-2 inhibitors. The risk seems to mainly apply to daily doses of 2400 mg, a finding borne out by epidemiological studies that showed no increased risk with ibuprofen 1200 mg. Two meta-analyses of clinical trials showed that all NSAIDs roughly double the risk of heart failure. One meta-analysis showed a small, statistically significant increase in the risk of atrial fibrillation. In practice, from a cardiovascular perspective, the NSAIDs of choice are ibuprofen, on condition that the dose does not exceed 1200 mg per day, and naproxen. In contrast, it would appear from the study data that cox-2 inhibitors, diclofenac and high-dose ibuprofen (2400 mg per day) are best avoided. As for other NSAIDs, the clinical data are too sparse to allow a meaningful comparison with the better studied NSAIDs. It is advisable to avoid using these other drugs.Rev Prescrire 2015; 35 (384): 748-750.
机译：非甾体抗炎药（NSAID）用作镇痛药使患者暴露于可从其药理学性质预测的心血管风险。截至2015年中期，关于NSAIDs选择的心血管危害，布洛芬和萘普伦的危害是什么？ NSAIDs对比较试验的大多数数据涉及COX-2抑制剂，双氯芬酸，布洛芬和萘普伦。少数研究已经解决了其他NSAID的严重心血管作用。 2013年，英国团队发表了大量的数百名随机试验，将NSAID与安慰剂或一个NSAID与另一个NSAID进行比较。与安慰剂相比，用COX-2抑制剂和双氯芬酸（约+ 40％）证明了严重心血管不良反应风险的统计学显着增加。这种风险主要是由于肌肉表盘呼吸和血管死亡的增加。另一个荟萃分析发现了在心血管死亡方面类似的结果。流行病学研究的结果与随机临床试验的结果一致。根据随机试验的荟萃分析，高剂量布洛芬将心血管风险增加到与双氯芬酸或COX-2抑制剂相同的程度。风险似乎主要适用于每日2400毫克的每日剂量，这是一种通过流行病学研究传承的发现，表明无水链接1200毫克没有增加风险。两种临床试验的荟萃分析表明，所有NSAID都大致增加了心力衰竭的风险。一个荟萃分析显示出心房颤动风险的小，统计学显着增加。在实践中，从心血管的角度来看，NSAIDs的选择是布洛芬，因为剂量不超过每天1200毫克，和萘普伦。相反，它将从研究数据中出现Cox-2抑制剂，双氯芬酸和高剂量布洛芬（每天2400mg）。至于其他NSAID，临床数据太稀疏，以允许与更好的研究NSAIDs进行有意义的比较。建议避免使用这些其他药物2015年预警; 35（384）：748-750。

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    《Prescrire international》 |2016年第167期|共3页
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