Diclofenac Gel and Cardiac Issues

Cardiovascular Risk Profile

• The American College of Cardiology notes that diclofenac is associated with a 54% increased risk of recurrent myocardial infarction in patients with cardiovascular risk factors 1, 2
• The American College of Cardiology also notes that diclofenac is associated with a 140% increased mortality risk compared to placebo in patients with cardiovascular risk factors 1

Specific High-Risk Populations

• The Journal of the American College of Cardiology reports hazard ratios for death of 2.40 in post-MI patients using diclofenac 3

Safer Alternatives

• The Journal of the American College of Cardiology recommends a stepped-care approach for patients requiring pain management with cardiac disease, including first-line use of acetaminophen, small doses of narcotics, or nonacetylated salicylates, and second-line use of naproxen if initial therapy is insufficient 3

Cardiovascular Risk and COX-2 Selectivity

• The American Heart Association recommends that cardiovascular risk is proportional to COX-2 selectivity, and diclofenac's high COX-2 inhibitory potency places it in a higher risk category similar to selective COX-2 inhibitors 2