Diclofenac Again Tied to Major Cardiovascular Events

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

A new study in The BMJ adds to mounting evidence on the cardiovascular risks of the nonsteroidal anti-inflammatory drug (NSAID) diclofenac.

Using Danish health registries, researchers identified nearly 1.4 million low-risk adults who filled first prescriptions for diclofenac between 1996 and 2016, comparing them with NSAID nonusers and with new users of ibuprofen, naproxen, and acetaminophen.

The rate of major adverse CV events within 30 days of starting diclofenac was 0.1%. Compared with NSAID nonusers, diclofenac initiators had a 50% increased risk for overall CV events, with significant risk increases seen for atrial fibrillation/flutter, stroke, myocardial infarction, heart failure, and cardiac death. Diclofenac was also associated with increased CV risk when compared with ibuprofen, naproxen, and acetaminophen.

The authors write, "It is time to acknowledge the potential health risk of diclofenac and to reduce its use. Diclofenac should not be available over the counter, and when prescribed, should be accompanied by an appropriate front package warning about its potential risks."