The cardiovascular safety of non-steroidal anti-inflammatory drugs (NSAIDs) has been reviewed in 2005, 2006, 2012 and 2013 as part of European-wide reviews, in which the UK participated. The 2006 European review concluded that some non-selective NSAIDS may be associated with a small increased risk of thrombotic events such as heart attack or stroke. The lowest effective dose of non-selective NSAID should be prescribed for the shortest possible time. The 2013 European review considered the balance of benefits and risks of the non-selective NSAID diclofenac. The review concluded that diclofenac has a thrombotic risk profile similar to that of the coxibs. The review recommended that the precautions already in place to minimise the risks of arterial thromboembolic events (blood clots in the arteries) with selective COX-2 inhibitors should also be applied to diclofenac. There is some evidence that naproxen may have a lower risk of heart attacks or strokes than selective Cox-2 inhibitors. Ibuprofen is a non-selective NSAID that has been available in low doses for many years as an over-the-counter medicine for short-term use. Current evidence does not suggest an increased thrombotic risk for short-term, low-dose treatment with ibuprofen. However, high-dose ibuprofen (which is not available over the counter) may be associated with a small increased thrombotic risk. Less evidence is available for other NSAIDs, but it is possible that they may be associated with a small risk of thrombotic events, especially with long duration of treatment and high doses. Since 2006, a number of further studies have been published which examine the risk of cardiovascular events (such as heart attacks) with NSAID use in the general population. This includes 2 important studies that both found that all NSAID users may be at an increased risk of cardiovascular events, not only those with baseline cardiovascular risk factors. These findings are in line with the conclusions of the 2006 review. A Public Assessment Report (published January 2010) presents a summary of the results from these 2 studies, and the conclusions based on the data. MHRA will continue to closely monitor the safety of all non-selective NSAIDs and coxibs.