Strategies to reduce heart disease risk from NSAIDs in high risk
- • Take low-dose ASA >2 hours before an NSAID.
- • Do not use NSAIDs for 3 to 6 months after a CV event or procedure.
- • Avoid extended-release NSAID preparations.
- • Control blood pressure.
- • Limit dose and frequency of NSAIDs and consider alternative analgesics if possible.
Several rheumatologic conditions are associated with an elevated baseline risk of CV disease. In some of these patients, however, the use of NSAIDs may provide a substantial improvement to quality of life. When counseling a patient regarding the risks of medication therapy, knowledge of absolute risk is important in addition to the strategies mentioned earlier. Metaanalyses suggest that the number needed to harm for development of a CV endpoint (fatal and nonfatal MI and stroke, as well as death due to vascular disease) with celecoxib lies at approximately 300 patients. Patients identified as having a high baseline risk (≥2% 1-year risk of CV event) face a slightly higher risk with exposure to celecoxib; for every 1000 patients treated, 7 more patients would have a CV endpoint after 1 year compared with placebo, 2 of which would be fatal. Understanding these risks should help in counseling patients.
