Even one week of NSAID Use linked to increased Heart Attack Risk

According to a meta-analysis in The BMJ , Use of non-steroidal anti-inflammatory drugs (NSAIDs) for even 1 week is associated with increased risk for myocardial infarction.

Dr.Michèle Bally and associates conducted a Systematic review and meta-analysis to characterise the determinants, time course, and risks of acute myocardial infarction associated with use of oral non-steroidal anti-inflammatory drugs (NSAIDs).

Eligible studies were sourced from computerised drug prescription or medical databases, conducted in the general or an elderly population, documented acute myocardial infarction as specific outcome, studied selective cyclo-oxygenase-2 inhibitors (including rofecoxib) and traditional NSAIDs, compared risk of acute myocardial infarction in NSAID users with non-users, allowed for time dependent analyses, and minimised effects of confounding and misclassification bias.

The researchers using individual patient data from four studies from healthcare databases, researchers identified over 61,000 cases of acute MI and 385,000 controls without MI. A cohort of 446 763 individuals including 61 460 with acute myocardial infarction was acquired. Taking any dose of NSAIDs for one week, one month, or more than a month was associated with an increased risk of myocardial infarction. With use for one to seven days the probability of increased myocardial infarction risk (posterior probability of odds ratio >1.0) was 92% for celecoxib, 97% for ibuprofen, and 99% for diclofenac, naproxen, and rofecoxib.

The researchers found that compared with NSAID non use, current use of each NSAID studied — including diclofenac, ibuprofen, naproxen, and celecoxib — was associated with increased MI risk. The elevated risk was not higher for celecoxib than for other NSAIDs.With use for longer than one month, risks did not appear to exceed those associated with shorter durations.

It was concluded that all NSAIDs, including naproxen, were found to be associated with an increased risk of acute myocardial infarction. Risk of myocardial infarction with celecoxib was comparable to that of traditional NSAIDS and was lower than for rofecoxib. Risk was greatest during the first month of NSAID use and with higher doses.The increased risk generally emerged during the first week of use and was highest during the first month. Higher doses were also associated with greater risks.

For more details click on the link : doi: https://doi.org/10.1136/bmj.j1909