Monday, 11 Dec 2017

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NSAIDs Increase Risk of Acute Myocardial Infarction

Using data from Canadian and European healthcare databases, the BMJ has reported that all NSAIDs, including celecoxib and naproxen, increase the risk of acute myocardial infarction.

While the recent 24,081 patient PRECISION study showed noninferiority between celecoxib, naproxen and ibuprofen with regard to CV risk, that study did not include a placebo arm.

Canadian researchers examined computerised drug prescription or medical databases for the use of selective COX-2 inhibitors (including rofecoxib) and traditional NSAIDs, and looked at the risk of acute myocardial infarction (AMI) in NSAID users with non-users.

 The cohort included 61,460 AMI cases and 385 303 controls (total of 446 763) who were receiving NSAIDs for one week, one month, or more than a month.

The risk of AMI immediately increased with NSAID exposure. Thus, with 1-7 days of NSAID use, AMI risk was significantly increased (with an adjusted odds ratio >1.0) for celecoxib (OR 1.24), ibuprofen (OR 1.48), diclofenac (OR 1.50), naproxen (OR 1.53), and rofecoxib (OR 1.58).

While higher doses were associated with greater risk of myocardial infarction, longer use risk did did exceed risks seen with shorter durations.

Conclusions 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.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Rheumatologists' Comments

1) a meta analysis of observational studies. Not very trustworthy. 2) CONFOUNDING
You hit the nail on the head. This is not novel, new or insightful data. It does little to shed light on a rare association. But because this is getting prominent play in the news, I posted the report for all to be aware, and hopefully look with a discriminating eye; as you have done. Thanks JJC

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