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Common painkillers increase risk for myocardial infarctions

Taking any dose of the nonsteroidal anti-inflammatory drugs ibuprofen, diclofenac, celecoxib or naproxen was associated with an increased risk for myocardial infarction, according to a systematic review and meta-analysis recently published in BMJ.

“Our work, which draws on large population-based cohorts created from administrative health or medical databases, is an innovative application of [individual patient data] meta-analysis for studying a drug-related adverse event,” Michèle Bally, BPharm, MSc, PhD, epidemiologist, department of pharmacy and research centre, Centre hospitalier de l’Université de Montréal, and colleagues wrote.

The cohort included 446,763 individuals including 61,460 with acute myocardial infarction (MI) who were enrolled in eight studies in the United Kingdom, Finland and Canada.

Bally and colleagues found that when the nonsteroidal anti-inflammatory drugs (NSAIDs) were used for 1 to 7 days, the probability of increased MI risk (posterior probability of odds ratio > 1) was 92% for celecoxib, 97% for ibuprofen, and 99% for diclofenac, naproxen and rofecoxib. The corresponding ORs were 1.24 (95% CI, 0.91-1.82) for celecoxib, 1.48 (95% CI, 1-2.26) for ibuprofen, 1.5 (95% CI, 1.06-2.04) for diclofenac, 1.53 (95% CI, 1.07-2.33) for naproxen and 1.58 (95% CI, 1.07-2.17) for rofecoxib.

In addition, greater risk for MI was documented for higher doses of NSAIDs. When NSAIDs were used longer than 1 month, risks did not appear to exceed those associated with shorter durations.

The researchers noted, however, that since the study is based on drug dispensing or prescribing, not all potentially influential factors could be taken into account.

“It is generally accepted that oral [NSAIDs] can increase the risk of acute [MI],” Bally and colleagues wrote. “The key advantages of this [individual patient data] meta-analysis is its’ pertinence of populations, power owing to sample size, relevance of exposure measurement, and posterior probability distributions.”

Researchers concluded with a warning.

“Prescribers should consider weighing the risks and benefits of NSAIDs before instituting treatment, particularly for higher doses," they wrote.

Previous research has found other possible risks associated with NSAID use, including increased risk for MI during acute respiratory infections, increased risk for lower gastrointestinal bleeding, and increased mortality risk from type 1 endometrial cancer. – by Janel Miller

Disclosure: Bally reports receiving grants from McGill University Health Centre Research Institute during the conduct of the study and personal fees from Institut national d’excellence en santé et services sociaux outside the submitted work. Please see the study for a list of the other authors relevant financial disclosures.