What do we know about communicating risk? A brief review and suggestion for contextualising serious, but rare, risk, and the example of cox-2 selective and non-selective NSAIDs

Table 3 Additional gastrointestinal bleeding events and myocardial infarction associated with using NSAIDs and coxibs

Event and drug	Relative risk	Additional events per 1,000	Additional deaths per 1,000	Frequency (1 in)
Gastrointestinal bleeding (background rate 2.2 per 1,000)
Ibuprofen	1.9	1.98	0.20	5,051
Naproxen	4.0	6.60	0.66	1,515
Diclofenac	3.3	5.06	0.51	1,976
All NSAIDs	4.2	7.04	0.70	1,420
Celecoxib	1.1	0.22	0.02	45,455
Rofecoxib	2.0	2.20	0.22	4,545
Myocardial infarction (background rate 8.2 per 1,000)
Ibuprofen	1.07	0.57	0.17	5,807
Naproxen	0.98	-0.16	-0.05	-20,325
Diclofenac	1.44	3.61	1.08	924
All NSAIDs	1.09	0.74	0.22	4,517
Celecoxib	0.96	-0.33	-0.10	-10,163
Rofecoxib	1.26	2.13	0.64	1,563

Any dose of drug was allowed in the data, and the table additionally shows the rate and frequency of additional events. The calculations used a mortality rate of 10% for gastrointestinal bleeding and 30% for cardiovascular events. NSAID, non-steroidal anti-inflammatory drug; coxib, cyclooxygenase-2 inhibitor.

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