The Cardiovascular Effects of Prolonged Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Abstract

The prolonged use of non-steroidal anti-inflammatory drugs (NSAIDs) has been associated with a variety of adverse cardiovascular effects, including an increased risk of myocardial infarction, stroke, heart failure, and hypertension. These drugs, widely used for pain and inflammation relief, work by inhibiting cyclooxygenase enzymes (COX-1 and COX-2), thereby reducing the synthesis of prostaglandins responsible for inflammation and pain. However, inhibiting these enzymes also affects cardiovascular homeostasis, particularly by disrupting the balance between thromboxane A2 and prostacyclin, substances involved in vascular function regulation and platelet aggregation.

Epidemiological studies and clinical trials have shown that prolonged use and high doses of NSAIDs, particularly those with higher selectivity for COX-2, are associated with an increased risk of adverse cardiovascular events. Patients with pre-existing risk factors, such as hypertension, diabetes, and a history of cardiovascular disease, are particularly vulnerable to the adverse effects of these medications.

The pathophysiology of NSAID-induced cardiovascular effects involves, in addition to the altered balance of prostaglandins, the potential for sodium and water retention, which can exacerbate hypertension and lead to congestive heart failure. Decreased renal function, another complication associated with prolonged NSAID use, also contributes to elevated blood pressure and overall cardiovascular risk.

In response to these risks, it is recommended that NSAIDs be used cautiously in patients with cardiovascular risk, employing the lowest effective dose for the shortest possible duration. Therapeutic alternatives, such as acetaminophen or opioids for pain management, may be considered, especially in patients at high cardiovascular risk. Additionally, regular monitoring of blood pressure and renal function is essential for patients requiring prolonged NSAID use.

In conclusion, while NSAIDs remain a valuable tool in the management of pain and inflammation, it is crucial that healthcare professionals be aware of the potential cardiovascular risks associated with their prolonged use, particularly in vulnerable populations. Individualized therapy, with careful consideration of the balance between risk and benefit, is essential for patient safety.