American Board of Family Medicine (ABFM) Practice Exam

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Which of the following NSAIDs is least likely to be associated with an increased risk of myocardial infarction?

Celecoxib
Diclofenac
Naproxen
Ibuprofen

The correct answer is: Naproxen

Naproxen is considered to have a more favorable cardiovascular safety profile compared to other nonsteroidal anti-inflammatory drugs (NSAIDs) like celecoxib, diclofenac, and ibuprofen. The reason for this is based on clinical studies and reviews of cardiovascular risks associated with NSAIDs. In the context of NSAID use, some medications like diclofenac and celecoxib have been linked to an increased risk of myocardial infarction, primarily due to their potential effects on blood pressure and endothelial function. Ibuprofen has also been associated with similar risks, particularly when used at higher doses or in longer durations. In contrast, naproxen has been shown in some studies to have a neutral or even protective effect on cardiovascular health, making it the option least likely to contribute to the risk of myocardial infarction. This has implications for clinicians when considering pain management and anti-inflammatory strategies, especially in patients who may already have pre-existing cardiovascular conditions or risk factors. Thus, when evaluating NSAIDs for their cardiovascular safety, naproxen stands out as the least likely to increase the risk of myocardial infarction among the options provided.