Roy M. Poses, MD, FACP
In patients who had a previous myocardial infarction (MI), does duration of treatment with nonsteroidal antiiflammatory drugs (NSAIDs) affect cardiovascular (CV) risk?
Cohort study with individual-level linkage of data from national registries.
83 677 patients ≥ 30 years of age (mean age 68 y, 63% men) who were hospitalized with a first MI between 1997 and 2006 and survived to hospital discharge. 42% of patients had ≥ 1 prescription for NSAIDs after discharge: 23% used ibuprofen, 13% diclofenac, 4.8% celecoxib, 4.7% rofecoxib, 2.2% naproxen, and 13% used other NSAIDs.
Duration of NSAID use after discharge. Treatment duration was estimated for each prescription by dividing the number of tablets dispensed by the estimated daily dosage. Analyses were adjusted for age, sex, concomitant medications, comorbidity (based on Ontario acute MI mortality prediction rule and hospital discharge codes ≤ 1 y before the index hospitalization), year of index hospitalization, and socioeconomic status (quintiles of average annual income).
Death and a composite endpoint of death or recurrent MI.
During follow-up, 35% of patients died, and 42% died or had recurrent MI. Overall, use of NSAIDs for any duration was associated with increased risk for mortality (Table). Duration of treatment associated with increased risk for mortality varied for individual NSAIDs (Table). Results were similar for the composite of mortality or recurrent MI.
In patients who had a previous myocardial infarction, use of nonsteroidal antiinflammatory drugs for any duration was associated with increased risk for mortality or recurrent myocardial infarction.
*MI = myocardial infarction; NSAID = nonsteroidal antiinflammatory drug.
†Hazard ratio > 1 indicates increased risk with NSAID use. Treatment duration boundaries confirmed by author.
Poses RM. NSAIDs were associated with increased risk for mortality or recurrent MI in patients who had previous MI. Ann Intern Med. ;155:JC4–11. doi: 10.7326/0003-4819-155-8-201110180-02011
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Published: Ann Intern Med. 2011;155(8):JC4-11.
Emergency Medicine, Hospital Medicine.
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