Diclofenac appears to increase the risk of cardiovascular events compared to other NSAIDs

Sobering research recently published in the BMJ suggests that diclofenac is not as safe as other first generation NSAIDs from a cardiovascular point of view. The study examined 1 370 832 diclofenac initiators, 3 878 454 ibuprofen initiators, 291 490 naproxen initiators, 764 781 healthcare-seeking paracetamol initiators matched by propensity score, and compared against 1 303 209 healthcare seeking non-initiators also matched by propensity score. Adverse events among diclofenac initiators was increased by 50% compared with non-initiators, 20% compared with paracetamol or ibuprofen initiators  and 30% compared with naproxen initiators. The endpoints included atrial fibrillation/flutter, ischaemic stroke, heart failure, myocardial infarction, and cardiac death. The absolute risk was highest in individuals with high baseline risk (that is, previous myocardial infarction or heart failure). Diclofenac also increased the risk of upper gastrointestinal bleeding at 30 days, by approximately 4.5-fold compared with no initiation, 2.5-fold compared with initiation of ibuprofen or paracetamol, and to a similar extent as naproxen initiation. One could be inclined to conclude that the availability of diclofenac for purchase without a prescription might best be re-considered?