Popular Cardiologist in yelahanka New Town, Bangalore • Non-steroidal anti-inflammatory drugs Non-steroidal anti-inflammatory drugs (NSAIDs) are in common use for arthritic and muscular pain. The traditional NSAIDs (and aspirin) inhibit both cyclo-oxygenase (COX) 1 and 2 iso-forms. The specific COX-2 inhibitors that are associated with a lower risk of gastrointestinal bleeding than the non-selective inhibitors have been widely used since their introduction. Reports of increased cardiovascular risk emerged first with rofecoxib, then with other COX-2 inhibitors, and then with the non-selective older drugs (but not aspirin). A large Finnish casecontrolled study of admissions with first myocardial infarction showed an average increased risk of 40% for users of these drugs.28 The study was complicated by its inability to track over-thecounter NSAIDs. Further work is underway, but patients with known ischaemic heart disease or at high risk should be discouraged from using these drugs.