{"id":4000,"date":"2013-02-12T00:00:00","date_gmt":"2013-02-12T05:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/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\/"},"modified":"2023-06-14T19:35:02","modified_gmt":"2023-06-14T23:35:02","slug":"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","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/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\/","title":{"rendered":"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"},"content":{"rendered":"<p><strong>Background<\/strong> &#x2014; Certain 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. The authors studied the extent to which evidence on cardiovascular risk with NSAIDs has translated into guidance and sales in 15 countries.<\/p>\n<p><span class=\"bold\">Methods and Findings<\/span> &#x2014; Data 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). Three drugs (rofecoxib, diclofenac, etoricoxib) ranked consistently highest in terms of cardiovascular risk compared with nonuse. Naproxen was associated with the lowest 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&#x2013;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%.<\/p>\n<p><strong>Conclusions<\/strong> &#x2014; Listing 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.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background &#x2014; Certain 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. The authors studied the extent to which evidence on cardiovascular risk [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[20,56],"migration-helper-qa-sample-set":[],"class_list":["post-4000","journal_article","type-journal_article","status-publish","hentry","topic-health-and-health-care-inequality","topic-pharmacoepidemiology-and-drug-safety"],"acf":{"citation":"McGettigan P, Henry D. <em>PLoS Med<\/em>. 2013; 10(2):e1001388. Epub 2013 Feb 12.","source_url":"http:\/\/journals.plos.org\/plosmedicine\/article?id=10.1371\/journal.pmed.1001388","ices_scientist":[1266],"site":[6733],"research_program":[6746],"news_release":[7433],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[],"downloads":null,"links":null,"sitecore_item_id":"C1001FAC-A941-4972-9E9A-4CFA38CF1FBB","sitecore_item_name":"Use-of-non-steroidal-anti-inflammatory-drugs-that-elevate-cardiovascular-risk","sitecore_field_values":"{\n  \"Title\": \"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\",\n  \"Short title\": \"Use of non-steroidal anti-inflammatory\",\n  \"Citation\": \"<p>McGettigan P, Henry D. <em>PLoS Med<\/em>. 2013; 10(2):e1001388. Epub 2013 Feb 12.<\/p>\",\n  \"Abstract\": \"<p><strong>Background<\/strong> &mdash; Certain 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. The authors studied the extent to which evidence on cardiovascular risk with NSAIDs has translated into guidance and sales in 15 countries.<\/p>n<p><span class=\"bold\">Methods and Findings<\/span> &mdash; Data 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). Three drugs (rofecoxib, diclofenac, etoricoxib) ranked consistently highest in terms of cardiovascular risk compared with nonuse. Naproxen was associated with the lowest 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&ndash;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%.<\/p>n<p><strong>Conclusions<\/strong> &mdash; Listing 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.<\/p>n<p><a href=\"http:\/\/journals.plos.org\/plosmedicine\/article?id=10.1371\/journal.pmed.1001388\" title=\"Opens external link\">View full text<\/a><\/p>\",\n  \"Keywords\": \"{B711DE54-5056-420D-AA0E-1349F1D88049}|{404E8236-468F-4DA1-8BA1-F405AC36275E}\",\n  \"Related Products\": \"<h2>News Release<\/h2>rn<h3><a href=\"~\/link.aspx?_id=BB63BDE08779465682405A498C4CE397&amp;_z=z\">Researchers call for the withdrawal of diclofenac worldwide<\/a><\/h3>\",\n  \"Research Programs\": \"{CFE36C89-C969-4C23-B5E4-1BA9E5BDC273}\",\n  \"ICES Locations\": \"{4FCAABBA-14A5-42E6-8F33-BC6C2F1D9908}\",\n  \"ICES Scientists\": \"{242795DE-E521-4AAA-A4DF-93AF84CC17CA}\",\n  \"Posted Date\": \"20130212T000000\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2013\/January\/Use-of-non-steroidal-anti-inflammatory-drugs-that-elevate-cardiovascular-risk"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | 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<\/title>\n<meta name=\"description\" content=\"Background &#x2014; Certain non-steroidal anti-inflammatory drugs (NSAIDs) (e.g., rofecoxib, Vioxx) increase the risk of heart attack and stroke and\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/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\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ICES | 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\" \/>\n<meta property=\"og:description\" content=\"Background &#x2014; Certain non-steroidal anti-inflammatory drugs (NSAIDs) (e.g., rofecoxib, Vioxx) increase the risk of heart attack and stroke and\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/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\/\" \/>\n<meta property=\"og:site_name\" content=\"ICES\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/ICESOntario\/\" \/>\n<meta property=\"article:modified_time\" content=\"2023-06-14T23:35:02+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.ices.on.ca\/wp-content\/uploads\/2024\/11\/ic-es-data-discovery-better-health-logo.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"675\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/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\\\/\",\"url\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/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\\\/\",\"name\":\"ICES | 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\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/#website\"},\"datePublished\":\"2013-02-12T05:00:00+00:00\",\"dateModified\":\"2023-06-14T23:35:02+00:00\",\"description\":\"Background &#x2014; 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