For a 67-year-old man at high risk of cardiovascular events with paracetamol ineffective, which NSAID has the lowest risk of cardiovascular events?

• A. Ibuprofen 400 mg QID
• B. Celecoxib 200 mg daily
• C. Naproxen 500 mg BD
• D. Diclofenac 50 mg TID

Answer: (C)

In managing pain for someone at high cardiovascular risk, the cardiovascular safety profile of NSAIDs matters a lot. Among standard NSAIDs, naproxen has the most favorable data for minimizing cardiovascular events, so it’s the preferred choice when an NSAID is necessary.

Naproxen tends to show the lowest associated risk of heart attack or stroke compared with other common NSAIDs. Diclofenac and COX-2 inhibitors like celecoxib carry higher cardiovascular risk, especially at higher doses. Ibuprofen sits between naproxen and the higher-risk NSAIDs, and it can interfere with aspirin’s cardioprotective effect if taken around the same time. So, for a patient at high CV risk who still needs NSAID therapy, naproxen is the best option among these.

Use should be at the lowest effective dose for the shortest duration, with monitoring for blood pressure, fluid retention, and GI risk, and consider non-NSAID analgesia if possible.