Assessment of nonsteroidal anti-inflammatory drug-induced cardiotoxicity

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs), including selective cyclooxygenase-2 inhibitors (coxibs) and traditional NSAIDs (tNSAIDs), have been widely used for the treatment of pain and rheumatic disease. The use of NSAIDs has been linked to increased cardiovascular toxicity in both healthy individuals and patients with established cardiovascular disease. Various recently published studies have raised concerns about the cardiovascular safety of NSAIDs; this review is focused on the cardiotoxic effects of NSAIDs. Areas covered: This review focuses on arthritis trials, placebo-controlled trials, meta-analyses, preclinical and observational studies associated with the use of NSAIDs-induced cardiotoxicity. It analyses the data given in these studies and discusses the cardiotoxic risk of NSAIDs. Expert opinion: Analysis of various clinical, preclinical, meta-analysis and observational studies showed that coxibs and tNSAIDs increase the risk of cardiotoxicity. Cardiotoxic risk depends on dose, duration and frequency of NSAID administration. Most studies were based on large medical databases with miscellaneous populations and pointed to an increase risk of cardiotoxicity under NSAID medication. The cardiotoxicity associated with use of NSAIDs might be due to inhibition of prostacyclin synthesis, oxidative stress, increase in blood pressure and impaired endothelial function.