Updates on NSAIDs in patients with and without coronary artery disease: pitfalls, interactions and cardiovascular outcomes

NSAIDs are used worldwide by more than 30 million people everyday, given their anti-inflammatory, analgesic and antipyretic effects. NSAIDs are approved for several common adult diseases, including acute and chronic musculoskeletal or inflammatory disease, osteoarthritis, rheumatoid arthritis and other arthritic conditions, as well as for children with juvenile idiopathic arthritis. Importantly, the population commonly taking NSAIDs is that of older individuals who also represent the population with the highest risk for cardiovascular (CV) and gastrointestinal adverse effects. In recent years, a growing body of evidence regarding potential risks from chronic use of NSAIDs has emerged. The aim of this review is to update the available data concerning chronic use of NSAIDs in patients with and without CV disease by analyzing the mechanisms of action, the interference of specific NSAIDs with the established CV protective role of low-dose aspirin, and the potential increased risk of myocardial infarction, stroke, hypertension, heart failure and atrial fibrillation.