Compared to Naproxen, Diclofenac use increased myocardial infarction risk in Ankylosing Spondylitis patients, but not in Osteoarthritis patients. Perhaps Diclofenac’s risk is made evident by an already inflammatory condition like AS.
Differences in Safety of Nonsteroidal Antiinflammatory Drugs in Patients With Osteoarthritis and Patients With Rheumatoid Arthritis: A Randomized Clinical Trial
“Treatment with celecoxib at approved dosages conferred a similar or lower risk of CV, GI, and renal adverse events compared with treatment with ibuprofen or naproxen in patients with OA and patients with RA.”
Among the non-selective COX-inhibitors, Ibuprofen and Naproxen are known to be relatively safer with regards to major adverse cardiovascular events. The relative safety of Celecoxib over Ibuprofen and Naproxen across the 3 outcomes (heart, gut, kidney) were more significant in OA than in RA patients, again possibly reflecting the higher inflammatory burden and baseline risks RA patients are already subjected to from their disease.
Adding Aspirin appears to negate any cardiovascular or renal benefit Celecoxib may confer over the use of Ibuprofen or Naproxen.