Non-Steroidal Antiinflammatory Drugs (NSAIDS) are the most commonly used drugs in the US according to the CDC.
Non-Steroidal Antiinflammatory Drugs (NSAIDS) are the most commonly used drugs in the US according to the CDC. NSAIDS address a wide range of maladies including pain, fever and inflammation. For this reason, they are commonly used by sports medicine physicians to treat orthopedic injuries and pain.
NSAID use is increasing over time and meloxicam is now the 30th most prescribed drug in the US. Participants over 60 years of age, women, participants with high body mass index, increased waist circumference or heart disease were significantly more likely to be regular NSAID users.Risks of long term NSAID use include cardiovascular disease, gastrointestinal ulceration and bleeding, kidney toxicity, and potential for hemorrhagic stroke. Aspirin is well accepted as an agent for the treatment and prevention of secondary cardiovascular effects events.
Current guidelines also support the role of aspirin for prevention of primary cardiovascular disease, although this is more contentious. Other NSAIDS do not convey the same cardioprotective benefits. Although sports medicine physicians are not treating many of the comorbidities of their patients, they need to be cognizant of the use of NSAIDS and individual cardiovascular risk.
For a period of time COX-2 inhibitors were preferred due to their favorable GI profile. However, in 2004 Rofecoxib (Vioxx) was found to increase cardiovascular events and taken off the market. Providers have since been debating the cardiovascular safety of both COX-2 inhibitors and traditional NSAIDS.
Table illustrating selectivity of various NSAIDS (courtesy of link.springer.com). In 2016 the New England Journal of Medicine posted a review comparing cardiovascular safety in Celecoxib, Naproxen and Ibuprofen in patients who have osteoarthritis or rheumatoid arthritis. The primary outcome in the study was death from cardiovascular causes and a secondary outcome was major adverse cardiovascular events.
If you are experiencing symptoms that may be related to nsaids and cardiovascular risk, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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