Can Natriuretic Peptide Levels Predict the Cardiovascular Complications of COX-2 Inhibitors and Nonsteroidal Anti-inflammatory Drugs?
Journal of the American Board of Family Medicine
There is evidence that fluid retention, whether due to a disease process or due to a medication, is associated with a number of cardiovascular diseases, including heart failure, strokes, coronary artery disease, and cardiovascular death. There is additional evidence that fluid retention that manifests as increased intravascular volume adversely affects cardiovascular outcomes. Because natriuretic peptide levels reflect intravascular volume and pressure, it is hypothesized that when patients are
... t when patients are prescribed medications that promote fluid retention-such as non-selective nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors-monitoring natriuretic peptide levels before and after initiating the medication may allow these medications to be used more safely. ( J Am Board Fam Med 2006;19: 178 -82.) Disease States and Cardiovascular Disease Heart Failure Heart failure is characterized by fluid retention. Patients with heart failure are more likely to die suddenly compared with persons with normal left ventricular ejection fractions, 2,3 and the lower the left ventricular ejection fraction, the higher the mortality rate. 4 In addition, heart failure increases the risk for the development of a stroke, 2,3,5-8 with the risk increasing as the left ventricular ejection fraction decreases. 9,10