Which is the safest NSAID for patients at elevated cardiovascular risk?

The issue of the cardiovascular risk associated with non-steroidal antiinflammatory drugs (NSAIDs) intensified recenty with the release of a systematic review of observational studies questioning the safety of diclofenac, a non-selective NSAID. In fact, this review demonstrated an increased cardiovascular risk for rofecoxib, diclofenac, meloxicam and indomethacin; a neutral effect was shown with celecoxib, naproxen and ibuprofen (although the lower bound of the 95% confidence interval for the latter approached, which is less than reassuring). Observational studies are limited in that they are generally based on the prescription of drugs via health care providers; this makes it difficult to discern what dosages have actually been taken, and whether subjects have used over-the-counter NSAIDs or concomitant low-dose aspirin.