scholarly journals Subgroup analyses to determine cardiovascular risk associated with nonsteroidal antiinflammatory drugs and coxibs in specific patient groups

2008 ◽  
Vol 59 (8) ◽  
pp. 1097-1104 ◽  
Author(s):  
Daniel H. Solomon ◽  
Robert J. Glynn ◽  
Kenneth J. Rothman ◽  
Sebastian Schneeweiss ◽  
Soko Setoguchi ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Antiinflammatory Drugs ◽  
Specific Patient ◽  
Subgroup Analyses ◽  
Patient Groups

The Editor's Roundtable: Nonsteroidal Antiinflammatory Drugs and Cardiovascular Risk

2008 ◽  
Vol 102 (8) ◽  
pp. 1046-1055 ◽  
Author(s):  
Vincent E. Friedewald ◽  
Joel S. Bennett ◽  
Milton Packer ◽  
William C. Roberts ◽  
Gary W. Williams
Keyword(s):  
Cardiovascular Risk ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Antiinflammatory Drugs

Nonselective Nonsteroidal Antiinflammatory Drugs and Cardiovascular Risk: Are They Safe?

2007 ◽  
Vol 41 (7-8) ◽  
pp. 1163-1173 ◽  
Author(s):  
Javier C Waksman ◽  
Aaron Brody ◽  
Scott D Phillips
Keyword(s):  
Cardiovascular Risk ◽  
Significant Risk ◽  
Case Control ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Double Blind Study ◽  
Case Control Studies ◽  
Antiinflammatory Drugs ◽  
Double Blind ◽  
Nsaid Treatment ◽  
Meta Analyses

Objective: To assess possible cardiovascular risks associated with use of nonselective nonsteroidal antiinflammatory drugs (NSAIDs). Data Sources: Medline and Embase were searched from January 1985 through April 2007 and relevant studies were retrieved. Study Selection and Data Extraction: Peer-reviewed, prospective, double-blind, case–control, and cohort-design studies published in the English language literature were considered eligible for review. Previous meta-analyses and systematic reviews were also analyzed. In total, 17 case–control studies; 9 cohort studies; 1 prospective, double-blind study; 3 meta-analyses; and 1 systematic review of observational studies were identified. Data Synthesis: Three studies were prospective and the remainder consisted of observational, retrospective studies, with most reporting acute fatal or nonfatal myocardial infarction as the cardiovascular endpoint. Among the nonselective NSAIDs, diclofenac appears to pose the highest risk for cardiovascular toxicity; other agents trend toward a neutral effect with respect to cardiovascular risk. Although the data are suggestive, it remains unclear whether naproxen provides protective cardiovascular effects among patients on chronic therapy. Conclusions: Currently available data are insufficient for defining evidence-based clinical guidelines for the use of NSAIDs, and the need for additional research, specifically randomized controlled trials, is evident. Diclofenac demonstrates a significant risk while naproxen appears to pose the lowest, albeit nonsignificant, risk for cardiovascular morbidity. Although the current clinical evidence may not warrant recommending naproxen as the preferred NSAID treatment, it may be prudent to avoid diclofenac for patients with cardiovascular risk factors requiring NSAID treatment.

scholarly journals Cause-Specific Cardiovascular Risk Associated With Nonsteroidal Antiinflammatory Drugs Among Healthy Individuals

2010 ◽  
Vol 3 (4) ◽  
pp. 395-405 ◽  
Author(s):  
Emil Loldrup Fosbøl ◽  
Fredrik Folke ◽  
Søren Jacobsen ◽  
Jeppe N. Rasmussen ◽  
Rikke Sørensen ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Healthy Individuals ◽  
Antiinflammatory Drugs

scholarly journals Inflammation and Hypertension in Rheumatoid Arthritis

2013 ◽  
Vol 40 (11) ◽  
pp. 1806-1811 ◽  
Author(s):  
Siriporn Manavathongchai ◽  
Aihua Bian ◽  
Young Hee Rho ◽  
Annette Oeser ◽  
Joseph F. Solus ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Insulin Resistance ◽  
Cardiovascular Risk ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Joint Disease ◽  
Model Assessment ◽  
Antiinflammatory Drugs ◽  
Necrosis Factor Alpha ◽  
Mediators Of Inflammation ◽  
Tnf Α

Objective.Hypertension (HTN), a common modifiable cardiovascular risk factor, is more common in patients with rheumatoid arthritis (RA), but the underlying mechanisms are unclear. We examined the hypothesis that mediators of inflammation and markers of cardiovascular risk are associated with HTN in RA.Methods.We compared measures of inflammation [serum C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), homocysteine, and leptin concentrations] and insulin resistance [homeostasis model assessment index (HOMA)] in RA patients with (n = 90) and without HTN (n = 79). HTN was defined as blood pressure ≥ 140/90 mm Hg or treatment with antihypertensive therapy. The independent association of markers of interest with HTN was examined using multivariable logistic regression.Results.Patients with HTN were significantly older and had longer disease duration than those without HTN (both p < 0.001). Concentrations of homocysteine [11.1 (8.5–13.5) μmol/l vs 9.3 (7.8–11.0) μmol/l] were significantly higher in patients with HTN (p < 0.001). After adjustment for age, sex, race, smoking, body mass index, and corticosteroid and nonsteroidal antiinflammatory drugs (NSAID) use, increased concentrations of homocysteine (OR 2.9, 95% CI: 1.5–5.5, p = 0.001), and leptin (OR 2.0, 95% CI: 1.0–3.8, p = 0.046) were significantly associated with HTN, but the 28-joint Disease Activity Score, IL-6, CRP, TNF-α, and HOMA index were not (all p > 0.05).Conclusion.HTN in patients with RA is not associated with generalized systemic inflammation or insulin resistance, but is associated with increasing concentrations of homocysteine and leptin. The pathogenesis of HTN in RA may involve pathways more regularly associated with fat and vascular homeostasis.

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