According to a commentary, this study adds to the bulk of evidence linking NSAID use with increased risk of heart failure, and further provides novel evidence on a dose-response relation. It notes that the main strength of the study was its size, linking information from four different European countries, and the consistency across countries. However, it adds that the clinical perspective of the study was limited, in that it only reported odds ratios and did not provide data on excess absolute risk- information on relative risk/odds ratios is not necessarily meaningful without knowing absolute risk, and hard to communicate to the people needing NSAIDs. Furthermore, information on absolute risks is valuable for clinicians and patients evaluating the balance between benefit and harm of treatment. They suggest that low risk patients might accept the small additional risk associated with treatment while higher risk patients might prefer to consider alternative treatments. They advise that for patients who do need NSAIDs, it is important to consider the different risk profiles of NSAIDs, with the selective COX 2 inhibitors and diclofenac repeatedly being associated with higher cardiovascular risk, and thus it would seem prudent to avoid them and consider lower risk naproxen at the lowest effective dose. They also point out that due to the widespread use of NSAIDs, even a small increase in cardiovascular risk is a concern for public health and this is reflected in advice from regulatory agencies and in a recent position paper by the European Society of Cardiology, which recommends against any use of diclofenac. However, despite these concerns, they note that NSAIDs are still widely available over the counter, without any provision of professional advice on their use or potential adverse effects, which they believe further fuels the common misconception that NSAIDs are harmless drugs that are safe for everyone. They call for a more restricted policy by regulatory authorities on the availability of NSAIDs and requirements for healthcare professionals to provide advice on their use and potential harm.