Background: Elderly patients with gastrointestinal (GI) and cardiovascular (CV) risk factors may be more easilyexposed to NSAID-related side effects (SEs). Based on the ACG guideline of year 2009, the aim of the study is toevaluate proper use of NSAIDs and gastroprotective drugs according to the degree of GI and CV risk strengths in thepatients. Methods: Retrospectively surveyed 410 elderly patients with NSAIDs for more than 30 days at a general hospitalin Korea. GI risk factor includes age, ulcer history, high-dose NSIADs, concurrent aspirin use, steroids or anticoagulants. CV risk factor includes angina, myocardial infarction, cerebral infarction, atrial fibrillation or coronaryintervention requiring low-dose aspirin. These factors were classified as high/low cardiovascular groups and high/moderate/low GI groups. Results: There were 14 patients in high CV risk group and high GI risk group. The group was recommendednot to use NSAIDs as it is not adequate. There were 101 patients in high CV risk group and moderate GIrisk group. This group was recommended to use naproxen and PPI/misoprostol. But all patients except one were notadequate. There were 9 patients in low CV risk group and high GI risk group. This group was recommended to useselective COX-2 inhibitor and PPI/misoprostol. 5 cases were proper while 4 cases did not. There were 285 patients inlow CV risk and moderate GI risk group who were recommended to use non selective NSAIDs and PPI/misoprostol orselective COX-2 inhibitor only. 103 patients were proper while 182 patients not adequate. Overall, the SEs were higherin those cases for inadequate use of drugs comparing to the adequate. CV SEs were statistically significant. However,SEs for each risk groups were different. For the case of low CV risk group and high/moderate GI risk group, the inadequateuse of drugs makes the SE high and the other groups are not. Also, it was not statistically significant. Conclusions:In elderly patients, the inappropriate use of NSAIDs can increase the risk of the disease. Therefore, GI and CVrisk must be considered simultaneously, and the proper use of NSAIDs and gastroprotective drugs for each risk groupsshould be reconsidered.