Non-steroidal anti-inflammatory drugs and risk of stroke in older patients: current controversies and research directions

Recent professional statements from established bodies, i.e. American Heart Association, European Medicines Agency, and Medicines and Healthcare products Regulatory Agency, have cautioned on the use of non-steroidal anti-inflammatory drugs (NSAIDs) given the potential increase in atherothrombotic risk associated with their long-term use. However, pharmacoepidemiological studies on the association between NSAID use and the risk of stroke, one of the leading causes of death, disability, and institutionalisation in old age, have shown contrasting results. Notably, very few such studies have addressed the risk in the older population, in particular patients >75-80 years, perhaps the biggest consumer group of these drugs. This article reviews the current evidence on the association between NSAIDs and risk of stroke in the older population. It also discusses the potential clinical, demographic, and pathophysiological factors potentially accounting for the discrepancies in the results of the pharmacoepidemiological studies and provides suggestions for future research directions.