What effect do selective NSAIDs have on cardiovascular health?

Selective nonsteroidal anti-inflammatory drugs (NSAIDs), often referred to as COX-2 inhibitors, have been associated with an increased risk of cardiovascular events, including myocardial infarction (MI) and stroke. This correlation is primarily due to the mechanism of action of these drugs, which selectively inhibit the COX-2 enzyme involved in the inflammatory response, while sparing COX-1, which plays a role in the protective lining of blood vessels and normal platelet function.

By inhibiting COX-2 without a corresponding inhibition of COX-1, selective NSAIDs can lead to an imbalance in vasodilation and platelet aggregation, resulting in increased vascular resistance and a heightened risk of thrombotic events. Clinical studies have demonstrated that long-term use of these medications can elevate the risk of both heart attack and stroke, particularly in patients with existing cardiovascular disease or risk factors.

Consequently, clinicians need to weigh the anti-inflammatory benefits of selective NSAIDs against their potential cardiovascular risks, particularly in patients who may be predisposed to cardiovascular conditions. This knowledge is crucial for safe prescribing practices and patient management.