Non-steroidal anti-inflammatory drug effects on renal and cardiovascular function: from physiology to clinical practice

Eur J Prev Cardiol. 2020 May;27(8):850-867. doi: 10.1177/2047487319848105. Epub 2019 May 14.

Abstract

Excessive or inappropriate use of non-steroidal anti-inflammatory drugs can affect cardiovascular and renal function. Non-steroidal anti-inflammatory drugs, both non-selective and selective cyclooxygenase 2 inhibitors, are among the most widely used drugs, especially in the elderly, with multiple comorbidities. Exposition to a polypharmacy burden represents a favourable substrate for the onset of non-steroidal anti-inflammatory drug-induced deleterious effects. Cardiovascular and renal issues concerning the occurrence of myocardial infarction, atrial fibrillation, heart failure and arterial hypertension, as well as acute or chronic kidney damage, become critical for clinicians in their daily practice. We discuss current available knowledge regarding prostanoid physiology in vascular, cardiac and renal systems, pointing out potential negative non-steroidal anti-inflammatory drug-related issues in clinical practice.

Keywords: Non-steroidal anti-inflammatory drugs; acute and chronic renal disease; arterial hypertension; atrial fibrillation; heart failure; myocardial infarction.

Publication types

  • Review

MeSH terms

  • Animals
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Cardiotoxicity
  • Cardiovascular Diseases / chemically induced*
  • Cardiovascular Diseases / metabolism
  • Cardiovascular Diseases / physiopathology
  • Cardiovascular System / drug effects*
  • Cardiovascular System / metabolism
  • Cardiovascular System / physiopathology
  • Humans
  • Kidney / drug effects*
  • Kidney / metabolism
  • Kidney / physiopathology
  • Renal Insufficiency, Chronic / chemically induced*
  • Renal Insufficiency, Chronic / metabolism
  • Renal Insufficiency, Chronic / physiopathology
  • Risk Assessment
  • Risk Factors

Substances

  • Anti-Inflammatory Agents, Non-Steroidal