Which statement about NSAID cardiovascular risk is correct?

• A. All NSAIDs have no cardiovascular risks
• B. NSAIDs are recommended for chronic CV prophylaxis
• C. NSAIDs cure CV disease
• D. Avoid use in patients with high risk for CV events

Answer: (D)

The main idea is that NSAIDs can raise the risk of cardiovascular events, so they should be avoided in people who are already at high cardiovascular risk. NSAIDs inhibit prostaglandin synthesis, which can tilt the balance toward a prothrombotic state and cause fluid retention and higher blood pressure. In someone with a history of heart attack, stroke, heart failure, or uncontrolled hypertension, this risk is clinically meaningful, making avoidance or very cautious, short-term use with the lowest effective dose appropriate. They do not cure cardiovascular disease and are not recommended for chronic cardiovascular prophylaxis. For pain relief in high-risk patients, safer options include acetaminophen, topical NSAIDs for localized pain, or nonpharmacologic approaches, and any NSAID use should be accompanied by close monitoring of blood pressure and renal function.