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Systematic review with meta-analysis
NSAID use associated with increased cardiovascular risk and death, but naproxen appears to be the least harmful
  1. Brian Bluhm1,
  2. Lee A Green1
  1. 1Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to: Lee A Green
    1018 Fuller SPC 1213, Ann Arbor, MI 48109, USA; greenla{at}umich.edu

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Context

Non-steroidal anti-inflammatory drugs (NSAIDs) are a cornerstone of the treatment of mild to moderate pain and are frequently used on a long-term basis for patients with arthritis. In 2004, rofecoxib, a cyclooxygenase-2 (COX-2) inhibitor, was removed from the market because of an increased risk of cardiovascular events associated with the drug.1 Subsequently, concern has grown about the cardiovascular safety of COX-2 inhibitors and traditional non-selective NSAIDs.2 Multiple studies with varying outcomes have not yet answered which, if any, NSAIDs are safe from a cardiovascular standpoint.

Methods

This was a network meta-analysis that involved large-scale randomised controlled trials comparing any NSAID with other NSAIDs or placebo. Selected studies had at least two arms with at least 100 patient years of follow-up. Trials that involved cancer patients were excluded. Data were …

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