Cardiovascular safety of nonsteroidal anti-inflammatory drugs

N.V. Chichasova^1,2, A.M. Lila^1,2

¹Research Institute of Rheumatology named after V.A. Nasonova, Moscow

²Russian Medical Academy of Continuous Professional Education, Moscow

The article is devoted to the problem of the safety of nonsteroidal anti-inflammatory drugs (NSAIDs) with an emphasis on their adverse events (AEs) in relation to the cardiovascular system. The association of these AEs to the mechanism of action of NSAIDs was discussed. It was indicated that for the AEs prevention, it is necessary to assess the risk factors for the development of complications associated with NSAIDs use. Factors of high and moderate cardiovascular risk were identified. The article discusses the interpretation complexity of the changes in the cardiovascular system due to the high incidence of comorbid conditions in the pathology of the musculoskeletal system, as well as the involvement of chronic inflammation in the genesis of atherosclerosis and, as a result, cardiovascular pathology development (or aggravation of the course). Data on the increase in the risk  of cardiovascular complications with dose increment of selective and non-selective NSAIDs were presented. It was noted that only very high doses of selective cyclooxygenase 2 (COX-2) inhibitors could be considered potentially dangerous in long-term continuous administration in groups with the risk of developing cardiovascular complications. The article also presents the data of a large-scale cohort study comparing cardiovascular risk during selective COX-2 inhibitors intake, according to which meloxicam has some superiority. The high safety of meloxicam was confirmed by the data of meta-analyses and systematic reviews, which showed that meloxicam did not worsen the course of arterial hypertension and coronary heart disease, did not aggravate edema, did not increase the incidence of myocardial infarction or thrombotic events. Meloxicam intake is associated with a slight increase in the combined risk of cardiovascular complications (risk ratio — 1.14, 95% confidence interval 1.04 d01.25), mainly its vascular component, without increasing myocardial and renal risk. It was noted that the simultaneous administration of meloxicam and acetylsalicylic acid to healthy volunteers did not affect the disaggregation effect of the latter.

Keywords: nonsteroidal anti-inflammatory drugs, NSAIDs, meloxicam, rofecoxib, celecoxib, non-selective NSAIDs, cardiovascular safety, risk, prevention.

For citation: Chichasova N.V., Lila A.M. Cardiovascular safety of nonsteroidal anti-inflammatory drugs. RMJ. 2021;6:75–80 (in Russ.).