EVIEW al astrointestinal and Cardiovascular Risks of Nonsteroid nti - inflammatory Drugs

onsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed but can have serious gastro inal (GI) and cardiovascular side effects, which have led to the withdrawal of some of these d ontinuing uncertainty about the best approach to patients requiring NSAID therapy, particularly i ith GI or cardiovascular risk factors. To define the risks to the GI and cardiovascular systems a ith NSAID therapy, we have undertaken a series of systematic reviews of original articles p etween January 1995 and December 2006. In this article we describe the mechanisms and patter nd cardiovascular side effects in NSAID-taking patients and identify a range of drug and patien hat contribute to an increased risk of adverse events. We conclude that NSAID therapy shoul tarted unless it is essential, and that Helicobacter pylori eradication should be considered in patients ncreased GI risk. We discuss the use of gastroprotective agents and provide practical advice hysicians assess and balance both cardiovascular and GI risks and benefits in their prescribing d 2008 Elsevier Inc. All rights reserved. • The American Journal of Medicine (2008) 121, 464-474