Short-term NSAID use increases CV risk in patients with prior MI
MedWire News: Short-term treatment with non-steroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk for death and myocardial infarction (MI) in people with a prior MI, Danish researchers report in Circulation.
Based on their findings, they warn that there is "no apparent safe therapeutic window for NSAIDs in patients with prior MI" and state that neither short- nor long-term treatment with NSAIDs in advisable in this population.
"We believe this message is important, and should be distributed as widely as possible to clinicians taking care of patients with cardiovascular disease," write Anne-Marie Schjerning Olsen (Copenhagen University Hospital, Denmark) and fellow authors.
Recent studies have found that NSAIDs are associated with increased cardiovascular (CV) risk, both in healthy individuals and in those with established CV disease. Furthermore, studies have identified acute or subacute effects of selective cyclo-oxygenase-2 inhibitors and non-selective NSAIDs on the CV system.
In this study, Olsen's team investigated the impact of NSAID treatment duration on CV risk. The study subjects were 83,675 people aged 30 years and older who suffered a first nonfatal MI between 1997 and 2006.
During follow-up, 42.3% of participants received NSAIDs and there were 35,257 deaths or recurrent MIs (42.1%). The most commonly used NSAIDs were ibuprofen (23.2%) and diclofenac (13.4%).
Time-to-event analyses revealed that NSAID therapy was associated with a significantly increased risk for death/MI at the beginning of treatment (hazard ratio [HR]=1.45) and that this increased risk persisted throughout the course of treatment (HR=1.55 at 90 days).
Analyses of individual drugs revealed that rofecoxib was associated with an increased risk for death/MI in the first week of treatment; celecoxib conferred an increased risk after 14-30 days of treatment; diclofenac was associated with an increased risk from the beginning of treatment and the risk persisted throughout treatment; and ibuprofen showed an increased risk when used for at least 1 week.
The authors say their results "challenge the view that NSAIDs are not harmful during short-term (1-week) treatment" and "support previous studies showing that patients with prior MI are at increased risk when taking NSAIDs."
They write: "Particularly worrying was the fact that the widely used non-selective NSAID diclofenac was associated with early and higher cardiovascular risk than the selective cyclooxygenase-2 inhibitor rofecoxib, which was withdrawn from the market in 2004 owing to its unfavorable CV risk profile."
They call for current recommendations regarding NSAID treatment in patients with established CV disease to be revised to take into account these new data.
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By Joanna Lyford