Are NSAIDs as dangerous as they are portrayed?

Consensus generally discourages the use of NSAIDs for those with hypertension, heart failure, or chronic kidney disease (CKD). In a recent retrospective cohort study, administrative claims were linked to examine a cohort of patients who were 65 years and older, seen in primary care visits for a musculoskeletal disorders – the unique aspect being that these patients also had a history of hypertension, heart failure, or CKD. The median physician-level prescribing rate for NSAIDs was 11.0% (interquartile range, 6.7%-16.7%) among 7365 primary care physicians. These patients were compared to a large group of non-exposed patient matched on the basis of their propensity score for prescription NSAID use (exposure). Th researchers found similar rates of cardiac complications (288 [0.8%] vs 279 [0.8%]), renal complications (34 [0.1%] vs 33 [0.1%]), and death (27 [0.1%] vs 30 [0.1%]). For cardiovascular and renal-safety related outcomes, there was no difference between exposed patients (308 [0.9%]) and non-exposed patients (300 [0.8%]). NSAIDs were commonly prescribed for high-risk patients, but this use was not associated with increased risk of short-term, safety-related outcomes. More in JAMA Internal Medicine here.