Diclofenac is a nonsteroidal anti-inflammatory drug prescribed to treat painful conditions and inflammatory diseases, like gout. One of the rare side effects of using diclofenac is the risk of cardiovascular diseases, like stroke, myocardial infarction, and ischemia. The objective of this study is to examine the cardiovascular risks of diclofenac initiation.

This is a series of 252 nationwide cohort studies that included a total of 1,370,832 diclofenac initiators, 3,878,454 ibuprofen initiators, 291,490 naproxen initiators, 764,781 paracetamol initiators, and 1,303,209 healthcare-seeking non-initiators. The primary objective of the study was the risk of cardiovascular events measured by Cox proportional hazards.

The risk of adverse events among diclofenac initiators was 50% more compared with non-initiators, 30% compared with naproxen initiators, and 20% compared with paracetamol and ibuprofen initiators. The incident event rate for diclofenac initiators was as follows: fibrillation (1.2), ischemic stroke (1.6), heart failure (1.7), and myocardial infarction (1.7). Diclofenac initiation was also associated with the risk of upper gastrointestinal bleeding by 4.5 times compared with no initiation and 2.5 times compared with the initiation of ibuprofen, paracetamol, and naproxen.

The research concluded that the initiation of diclofenac was associated with a significant risk of cardiovascular events when compared with no initiation, as well as the initiation of other traditional nonsteroidal anti-inflammatory drugs.

Ref: https://www.bmj.com/content/362/bmj.k3426