Cardiovascular effects of the use of nonsteroidal anti-inflammatory drugs in patients with a history of cardiovascular disease
Keywords:
ANTIINFLAMATORIOS NO ESTEROIDEOS; EFECTOS FISIOLÓGICOS DE LAS DROGAS; ENFERMEDADES CARDIOVASCULARES., ANTI-INFLAMMATORY AGENTS, NON-STEROIDAL; PHYSIOLOGICAL EFFECTS OF DRUGS; CARDIOVASCULAR DISEASES., ANTI-INFLAMATÓRIOS NÃO ESTEROIDES; EFEITOS FISIOLÓGICOS DE DROGAS; DOENÇAS CARDIOVASCULARES.Abstract
Introduction: non-steroidal anti-inflammatory drugs are widely prescribed for pain and inflammation, but their cardiovascular safety raises concerns in patients with cardiac history.
Objective: to describe the association between diclofenac and ibuprofen and the incidence of cardiovascular events in individuals with pre-existing cardiovascular disease.
Methods: a systematic review of the scientific literature was conducted across multiple databases. The search was performed using an algorithm with keywords and Boolean operators, allowing the identification of relevant sources. The selected studies, after applying inclusion and exclusion criteria, were critically analyzed considering timeliness, methodological quality, and thematic relevance, and were integrated into the final synthesis of the review.
Development: the literature shows that diclofenac significantly increases mortality and cardiovascular events, with risks exceeding 90 % in some studies, while ibuprofen demonstrates moderate increases, close to 30 %. The mechanisms involve inhibition of cyclooxygenase-2, disruption of prostaglandin balance, and effects on blood pressure and fluid retention. Meta-analyses confirm a higher risk of myocardial infarction and sudden death with diclofenac, whereas ibuprofen, although safer, also raises the likelihood of acute coronary syndrome and stroke with prolonged use.
Conclusions: the comparative analysis confirms that diclofenac presents a more unfavorable cardiovascular profile than ibuprofen, especially in patients with cardiac history. It is recommended to limit its prescription and prioritize safer alternatives, always considering individual risk factors and the need for rational use of anti-inflammatory drugs.
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