NSAID strategy to minimize cardiovascular risk in OA?

• A. Intermittent high-dose therapy
• B. Highest tolerated dose for long duration
• C. Continuous NSAID with no breaks
• D. Lowest effective dose for shortest duration

Answer: (D)

Minimizing cardiovascular risk from NSAIDs comes down to limiting systemic exposure: use the lowest dose that provides adequate relief for the shortest possible duration. The cardiovascular risks of NSAIDs—such as high blood pressure, edema, heart failure exacerbation, and increased risk of heart attack or stroke—rise with higher doses and longer use. By starting with the smallest effective amount and stopping or reassessing as soon as possible, you reduce both the magnitude and the duration of these risks. If pain can be controlled with nonpharmacologic measures or with topical NSAIDs for localized joints, those options further limit systemic exposure. In patients with higher CV risk, this strategy becomes even more important, and NSAIDs should be used sparingly, with careful consideration of patient-specific factors.