Diclofenac (e.g., Voltaren), the widely used nonsteroidal anti-inflammatory agent, "exerts the same risk for cardiovascular adverse events as rofecoxib," according to a Danish study published in Circulation: Cardiovascular Quality and Outcomes. (Rofecoxib [Vioxx] was removed from the market in 2004.)

Using national databases, investigators identified a cohort of over 1 million healthy individuals aged 10 and older. Over a 9-year period, the investigators tracked the subjects' use of NSAID therapy within 30 days of a major cardiovascular event.

Use of the nonselective NSAID diclofenac was associated with an almost twofold increased risk for cardiovascular death (odds ratio, 1.91); in comparison, the odds ratio with rofecoxib was 1.66. There was a dose-dependent increase in risk. Both ibuprofen and naproxen showed increased stroke risk, although naproxen had the safest overall risk profile.

Acknowledging the limitations of their observational study, the authors conclude that their findings expose "a major public health issue." They caution physicians to carefully assess cardiovascular risks before starting NSAID treatment.