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Meta-analysis Indicates NSAIDs Linked with Increased Risk for Heart Attack
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Researchers of this systematic review of studies from Canadian and European databases and a meta-analysis of individual patient data found NSAID use was linked with an increased risk for myocardial infarction.
Michéle Bally, MSc, PhD, from the University of Montreal, and colleagues included eight studies of 446,763 people, which included 385,303 controls and 61,460 cases of heart attack.
Investigators found any NSAID dose administered for 1 week, 1 month or greater than 1 month was linked with an increased risk for myocardial infarction (MI). For use up to 1 week, MI was linked with celecoxib (ratio = 1.24), ibuprofen (ratio = 1.48), diclofenac (ratio = 1.5), naproxen (ratio = 1.53) and rofecoxib (ratio = 1.58), and there was increased risk for higher doses. However, after use of more than 1 month, the risk did not increase.
“Risk was greatest during the first month of NSAID use and with higher doses,” the researchers wrote. – by Will A. Offit
Disclosures: Bally reports no relevant financial disclosures. Please see the full study for a list of all other relevant disclosures.
Perspective
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Calvin Brown Jr., MD
This article reports that all NSAIDs, including celecoxib and naproxen, increase the risk of acute myocardial infarction. Canadian researchers examined drug prescription and medical databases for the use of selective COX-2 inhibitors (including rofecoxib) and traditional NSAIDs, and looked at the risk of acute myocardial infarction in NSAID users with non-users. The risk of acute myocardial infarction immediately increased with NSAID exposure. Higher doses were associated with greater risk of myocardial infarction, but longer use risk did exceed risks seen with shorter durations.
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, consistent with the recent PRECISION trial, and was lower than for rofecoxib. Risk was greatest during the first month of NSAID use and with higher doses. Keep in mind the PRECISION study showed noninferiority between celecoxib, naproxen and ibuprofen with regard to cardiovascular risk, but importantly, that study did not include a placebo arm.
In summary, this study continues to show this is a rare association. Unfortunately, the study does not shed any new light on this association; nevertheless, it is likely to get prominent play in the news.
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