Caught Between A Rock And A Hard Place - Part 4

Wow!  Non-steroidal anti-inflammatory drugs (NSAIDs) are really taking a hit.  Just last Monday, I pointed out a link with atrial fibrillation.  A few months ago, I pointed out a link with erectile dysfunction.  Granted, these results are associative in nature rather proof of cause & effect.  However, a third strike comes this month linking NSAIDs to all-cause mortality, mainly due to cardiovascular disease in patients w/known hypertension & heart disease.

What's interesting is that aspirin is also a member of the NSAID class yet it gets a pass and multiple studies have demonstrated benefit in preventing deaths, heart attacks & strokes (although there is a small but real risk of hemorrhagic stroke & major bleeding).  Far be it for me to be able to explain why this is.  We've attempted to cull the benefit of aspirin and separate it from its pitfalls by developing Cox 2 inhibitors, a subclass of NSAIDs.  However, of the many Cox 2 inhibitors that reached the market at the beginning of the century, only one remains on the market, and even that one, celecoxib, has lost much of its glow.

So how did the authors reach their conclusion linking NSAIDs to mortality?  They analyzed the data after the fact from 21,694 individuals who didn't use NSAIDs regularly and 882 who did in the INternational VErapamil Trandolapril STudy (INVEST).  Any time the results from a study are used in a manner not originally intended, any conclusions derived are only good for generating hypotheses.  The authors noted that after less than 3 years follow up, there were a statistically significant 4.4 events per 100 patient-years in the those who took NSAIDs regularly compared to just 3.7 events per 100 patient-years in those who didn't, mostly due to cardiovascular deaths.

These results aren't just due to chance but you're looking at "only" 5 extra deaths per 1,000 patient-years.  We already know that NSAIDs are hard on the kidneys, increase blood pressure and your risk of gastrointestinal bleeding & intracerebral hemorrhage.  It's up to you to decide if chronic pain control is worth the potential for an increase in all-cause mortality if you also have high blood pressure & heart disease.  Remember, this is currently just an association, not a proven cause & effect.