The use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk of gastrointestinal events such as peptic ulcer or gastrointestinal bleeding, and also to cardiovascular events such as myocardial infarction or stroke. The evidence on these adverse events reported in recent years is very clear, and therefore the prescription or use of these drugs requires an accurate indication and evaluation of the risks and benefits. The evaluation of them is not always easy in daily clinical practice, as well as following the recommendations emanated from different national or international consensus or guidelines. This gastrointestinal and cardiovascular risk calculator aimed at patients requiring NSAIDs seeks to facilitate this process and is based on the most recent studies published on the subject. In fact, the calculator follows the recommendations published by three scientific societies such as the Spanish Society of Rheumatology, the Spanish Society of Cardiology and the Spanish Association of Gastroenterology. These recommendations are no different but very similar to those emanated from other international societies or to the recent expert consensus report published in BMC Medicine, and are in line with the most recent studies published in the New England Journal of Medicine or The Lancet in 2016 or 2017 (See references).
The CV risk has been estimated based on the FRESCO study under the following considerations Low CV risk (low risk <10% in Framingham) and (5 to 9.9%) in Fresco, Intermediate CV risk (intermediate risk 10-20% in Framingham) = high (10 to 14.9%) in Fresco; very high CV risk (high risk >20% in Framingham) = High risk (15% and higher) in Fresco.
Lanas A, Benito P, Alonso J, Hernández-Cruz B, Barón-Esquivias G, Perez-Aísa Á, Calvet X, García-Llorente JF, Gobbo M, Gonzalez-Juanatey JR; Spanish Society of Rhematology; Spanish Association of Gastroenterology; Spanish Society of Cardiology. Safe prescription recommendations for non steroidal anti-inflammatory drugs: consensus document ellaborated by nominated experts of three scientific associations (SER-SEC-AEG). Reumatol Clin. 2014 Mar-Apr;10(2):68-84
Scarpignato C, Lanas A, Blandizzi C, Lems WF, Hermann M, Hunt RH; International NSAID Consensus Group. Safe prescribing of non-steroidal anti-inflammatory drugs in patients with osteoarthritis--an expert consensus addressing benefits as well as gastrointestinal and cardiovascular risks. BMC Med. 2015 Mar 19;13:55.
Nissen SE, Yeomans ND, Solomon DH, Lüscher TF, Libby P, Husni ME, Graham DY, Borer JS, Wisniewski LM, Wolski KE, Wang Q, Menon V, Ruschitzka F, Gaffney M, Beckerman B, Berger MF, Bao W, Lincoff AM; PRECISION Trial Investigators. Cardiovascular Safety of Celecoxib, Naproxen, or Ibuprofen for Arthritis. N Engl J Med. 2016 Dec 29;375(26):2519-29.
Coxib and traditional NSAID Trialists' (CNT) Collaboration, Bhala N, Emberson J, Merhi A, Abramson S, Arber N, Baron JA, Bombardier C, Cannon C, Farkouh ME, FitzGerald GA, Goss P, Halls H, Hawk E, Hawkey C, Hennekens C, Hochberg M, Holland LE, Kearney PM, Laine L, Lanas A, Lance P, Laupacis A, Oates J, Patrono C, Schnitzer TJ, Solomon S, Tugwell P, Wilson K, Wittes J, Baigent C. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013 Aug 31;382(9894):769-79. doi: 10.1016/S0140-6736(13)60900-9. Epub 2013 May 30.
Chan FKL, Ching JYL, Tse YK, Lam K, Wong GLH, Ng SC, Lee V, Au KWL, Cheong PK, Suen BY, Chan H, Kee KM, Lo A, Wong VWS, Wu JCY, Kyaw MH. Gastrointestinal safety of celecoxib versus naproxen in patients with cardiothrombotic diseases and arthritis after upper gastrointestinal bleeding (CONCERN): an industry-independent, double-blind, double-dummy, randomised trial. Lancet. 2017 Apr 11. pii: S0140-6736(17)30981-9. doi: 10.1016/S0140-6736(17)30981-9. [Epub ahead of print]
Baena-Díez JM, Subirana I, Ramos R, Gómez de la Cámara A, Elosua R, Vila J, Marín-Ibáñez A, Guembe MJ, Rigo F, Tormo-Díaz MJ, Moreno-Iribas C, Cabré JJ, Segura A, Lapetra J, Quesada M, Medrano MJ, González-Diego P, Frontera G, Gavrila D, Ardanaz E, Basora J, García JM, García-Lareo M, Gutiérrez-Fuentes JA, Mayoral E, Sala J, R Degano I, Francès A, Castell C, Grau M, Marrugat J. Validity Assessment of Low-risk SCORE Function and SCORE Function Calibrated to the Spanish Population in the FRESCO Cohorts. Rev Esp Cardiol (Engl Ed). 2017 May 26. pii: S1885-5857(17)30259-1. doi: 10.1016/j.rec.2017.03.030. [Epub ahead of print] English, Spanish.