ASK DIS: NSAIDS: Safety in Cardiovascular Disease

NSAIDS are used therapeutically most often as anti-inflammatory agents in conditions of inflammation and pain, mostly of a non-urologic nature.
A meta-analysis of primarily short-term trials found that all NSAIDs except naproxen were associated with similar increased risks of heart attack compared with placebo in elderly patient.¹
Naproxen may be a better choice for people who have higher risk of heart attacks or strokes, since the available evidence indicates it does not increase the risk of these conditions.
It is important to consider the duration and frequency of therapy of NSAIDS if patient is having risk of cardiovascular disease. (short duration therapy can be opt for patient at risk of cardiovascular disease)
The risk of adverse cardiovascular events such as myocardial infarction, stroke, or cardiovascular death is extremely small over a short course of therapy, as might be used for patients with an acute but limited musculoskeletal injury.¹
The American Heart Association recommends a “stepped care” approach to medication therapy for people with CVD who have musculoskeletal aches and pains. A person would be started on medications that have the lowest reported risk for cardiovascular events, and then, if needed, move step by step to other medications, with consideration of the risks versus the benefits at each step.²

Start with OTC medications acetaminophen or aspirin, the prescription medication tramadol, or short-term painkillers containing a narcotic. If necessary, go to
Aspirin-like drugs (nonacetylated salicylates). If necessary, go to
Non-COX-2 selective NSAIDs. If necessary, go to
NSAIDs with some COX-2 activity. If necessary, go to
COX-2 selective NSAIDs.

Reference

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