SynthesisPLoS medicine2013
Use of non-steroidal anti-inflammatory drugs that elevate cardiovascular risk: an examination of sales and essential medicines lists in low-, middle-, and high-income countries.
Synthesis in PLoS medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 104 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
104 citing papers in PubMed, 3 syntheses or guidelines pooled it, 406 citations in OpenAlex.
- Diclofenac for acute postoperative pain in children.The Cochrane database of systematic reviews · 2023Pooled it
- Pooled it
- Relative efficacy and safety of topical non-steroidal anti-inflammatory drugs for osteoarthritis: a systematic review and network meta-analysis of randomised controlled trials and observational studies.British journal of sports medicine · 2018Pooled it
- Analgesic Efficacy of Ibuprofen and Diclofenac Potassium on Postoperative Endodontic Pain in Maxillary and Mandibular First Molars with Irreversible Pulpitis: A Randomised Controlled Trial.European endodontic journal · 2023Trial
- Effect of Systematic Exercise Rehabilitation on Patients With Knee Osteoarthritis: A Randomized Controlled Trial.Cartilage · 2021Trial
- Efficacy of celecoxib versus ibuprofen for the treatment of patients with osteoarthritis of the knee: A randomized double-blind, non-inferiority trial.The Journal of international medical research · 2017Trial
- Pharmacokinetic and pharmacodynamic evaluation according to absorption differences in three formulations of ibuprofen.Drug design, development and therapy · 2017Trial
- Evaluation of the anti-inflammatory potentials of ethanol leaf extract of Vigna unguiculata in Wistar rats.Inflammopharmacology · 2026Article
- Toxicity of Four Common Environmental Chemicals Across Caenorhabditis elegans Life Stages Supporting the One Health Concept.Environmental toxicology · 2026Article
- Review
- Non-steroidal anti-inflammatory drug use in patients with varying severity of coronary artery disease.European journal of clinical pharmacology · 2026Article
- C(spMedicinal chemistry research : an international journal for rapid communications on design and mechanisms of action of biologically active agents · 2026Article
- Acute and Chronic Toxicity of Ketoprofen Active Pharmaceutical Ingredient and Commercial Formulations to the Freshwater Photosynthetic SpeciesInternational journal of environmental research and public health · 2026Article
- Comparative Profiling ofFood science & nutrition · 2026Article
- Electrochemical detection of diclofenac and clindamycin using ZnO nanorods/RGO nanocomposite modified electrode.RSC advances · 2025Article
- Mechanisms of transport and analgesic compounds recognition by glycine transporter 2.Proceedings of the National Academy of Sciences of the United States of America · 2025Article
- Do nonsteroidal anti-inflammatory drugs increase the risk of atrial fibrillation after non-cardiac surgery? Insights from translational and clinical research.Journal of anesthesia, analgesia and critical care · 2025Review
- Exploring the Cardiovascular Safety Profile of Ibuprofen: Insights from EudraVigilance Database.Pharmaceuticals (Basel, Switzerland) · 2025Article
- Evaluation of the Antinociceptive Effect of Sesamin: Role of 5HTPharmaceutics · 2025Article
- New Evidence on Diclofenac: Implications for Cardiovascular Safety.Cardiovascular drugs and therapy · 2025Article
44 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
Authors and funding
2 authors at 2 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCertain non-steroidal anti-inflammatory drugs (NSAIDs) (e.g., rofecoxib [Vioxx]) increase the risk of heart attack and stroke and should be avoided in patients at high risk of cardiovascular events. Rates of cardiovascular disease are high and rising in many low- and middle-income countries. We studied the extent to which evidence on cardiovascular risk with NSAIDs has translated into guidance and sales in 15 countries. METHODS AND
findingsData on the relative risk (RR) of cardiovascular events with individual NSAIDs were derived from meta-analyses of randomised trials and controlled observational studies. Listing of individual NSAIDs on Essential Medicines Lists (EMLs) was obtained from the World Health Organization. NSAID sales or prescription data for 15 low-, middle-, and high-income countries were obtained from Intercontinental Medical Statistics Health (IMS Health) or national prescription pricing audit (in the case of England and Canada). Three drugs (rofecoxib, diclofenac, etoricoxib) ranked consistently highest in terms of cardiovascular risk compared with nonuse. Naproxen was associated with a low risk. Diclofenac was listed on 74 national EMLs, naproxen on just 27. Rofecoxib use was not documented in any country. Diclofenac and etoricoxib accounted for one-third of total NSAID usage across the 15 countries (median 33.2%, range 14.7-58.7%). This proportion did not vary between low- and high-income countries. Diclofenac was by far the most commonly used NSAID, with a market share close to that of the next three most popular drugs combined. Naproxen had an average market share of less than 10%.
conclusionsListing of NSAIDs on national EMLs should take account of cardiovascular risk, with preference given to low risk drugs. Diclofenac has a risk very similar to rofecoxib, which was withdrawn from worldwide markets owing to cardiovascular toxicity. Diclofenac should be removed from EMLs.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.