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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 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.

Can Natriuretic Peptide Levels Predict the Cardiovascular Complications of COX-2 Inhibitors and Nonsteroidal Anti-inflammatory Drugs?