Which NSAID is considered most appropriate for a patient with a history of myocardial infarction when NSAID use is necessary?

• A. Diclofenac
• B. Naproxen
• C. Ibuprofen
• D. Indomethacin

Answer: (B)

When an NSAID is necessary in someone with a history of MI, the priority is minimizing cardiovascular risk. All NSAIDs can raise the chance of further heart events, but some have a steadier CV safety profile than others. Naproxen is generally regarded as having the lowest cardiovascular risk among the commonly used NSAIDs, whereas others like diclofenac, indomethacin, and ibuprofen are associated with higher CV risk or adverse interactions with cardioprotective therapies such as low-dose aspirin. Therefore, if an NSAID must be used, naproxen at the lowest effective dose for the shortest duration is the best option in this context. Be mindful of potential renal and blood pressure effects, and coordinate carefully if the patient is also taking antiplatelet therapy.