Diclofenac and other NSAIDs are associated with increased risk for cardiovascular events in some patients

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“The nonsteroidal anti-inflammatory drug (NSAID) diclofenac , a drug that is frequently used for the treatment of pain and inflammation caused by arthritis, is associated with a significantly increased risk of cardiovascular complications and should be removed from essential-medicines lists (EML), according to a new review [1].” The study showed that diclofenac increases risk of an cardiovascular event occurring by 38% - 63% (absolute 95 th percentile range across all studies -15% to 199%).

It is clear that long term use of some NSAIDS is associated with increased risk of coronary events, especially those with previous myocardial infarction. I don't think at this stage the report needs to be acted upon by withdrawing from sale all diclofenac, but rather, a much better targeting of its use is required, with better appreciation for its potential interaction with those with cardiovascular disease. Like America, diclofenac is not the most commonly used NSAID here. The Australian Statistics on Medicines 2010 report < http://www.pbs.gov.au/statistics/asm/2010/australian-statistics-on-medicine-2010.pdf > (accessed 18 February 2013). It (and other drugs) also affect the kidney and can cause significant renal impairment (e.g. Lobox, K.K. Drug combinations and impaired renal function – the ‘triple whammy' Br J Clin Pharmacol. 2005 February; 59(2): 239–243. doi: 10.1111/j.1365-2125.2004.02188.x)

To put this into perspective, paracetamol (not combined with anything else) is the seventh most commonly used drug in Australia amounting to 28.172 defined daily dose (DDD) units (each daily dose is equivalent to 6 tablets of 500 mg each) per thousand population per day. In 2010 there were approximately 3.302 DDD/1000/day for diclofenac (The DDD is 2 tablets of 50 mg per day) and for naproxen 3.567 DDD/1000/day (two tables of 250 mg per day), noting that since some of these products can be purchased without a prescription the statistics are gained from survey data which always require some caution when applying to comparisons.

The DDD is a WHO definition based on the assumed average dose per day of the drug in an adult.

McGettigan P, Henry D. Use of non-steroidal anti-inflammatory drugs that elevate cardiovascular risk: An examination of sales and essential medicine lists in low-, middle-, and high-income countries. PLoS Med 2013; DOI:10.1371/journal.pmed.1001388