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Regular use of some NSAIDs moderately increased CV risk in postmenopausal women
Regular use of nonsteroidal anti-inflammatory drugs such as celecoxib and naproxen may increase the risk for CV events among postmenopausal women, according to a new report.
Researchers observed a modest increase in risk for CV events with regular use of selective cox-2 inhibitors, including celecoxib, and nonselective NSAIDs with cox-2>cox-1 inhibition, including naproxen. Nonselective NSAIDs with cox-1>cox-2 inhibition such as ibuprofen were not associated with increased risk for CV events.
The study included participants from the Women’s Health Initiative study of postmenopausal women aged 50 to 79 years enrolled between October 1993 and December 1998 (n=161,808).
Anthony A. Bavry
“Existing reports have not studied a suitable number of women to determine the potential cardiovascular effects of NSAIDs in women,” Anthony A. Bavry, MD, MPH, associate professor of medicine at University of Florida, Gainesville, and colleagues wrote.
The researchers discerned medication use from pill bottles brought by participants to clinic visits and stratified patients by NSAID use: nonuse; selective cox-2 inhibitors (refecoxib and celecoxib); nonselective NSAIDs with more cox-2 than cox-1 inhibition (naproxen); or nonselective NSAIDs with more cox-1 than cox-2 inhibition (ibuprofen). They ascertained CV outcomes by analyzed self-administered medical history updates and confirmed deaths via the National Death Index. All participants were followed until 2005, and 71.3% consented to follow-up until 2010. Mean follow-up was 11.2 years. The primary outcome was a composite of CV death, nonfatal MI and nonfatal stroke.
Compared with nonuse, regular NSAID use was associated with increased risk for CV events (HR=1.1; 95% CI, 1.06-1.15). Use of selective cox-2 inhibitors was associated with increased risk for CV events (HR=1.13; 95% CI, 1.04-1.23), but not when used in conjunction with aspirin. In addition, use of NSAIDs with cox-2>cox-1 inhibition was associated with increased risk for CV events (HR=1.17; 95% CI, 1.1-1.24), regardless of concomitant aspirin use.
However, there was no elevated risk for CV events among users of NSAIDs with cox-1>cox-2 inhibition (HR=1.01; 95% CI, 0.95-1.07). Therefore, these drugs “may be safer from a [CV] perspective for long-term use among postmenopausal women,” the researchers concluded.
Disclosure: The study was funded by the NHLBI. Bavry is a contractor for the American College of Cardiology’s Cardiosource. The other researchers report no relevant financial disclosures.