Steven M. Belknap, MD, FACP, FCP
Does cardiovascular (CV) risk associated with use of nonsteroidal antiinflammatory drugs (NSAIDs) after a first myocardial infarction (MI) differ by time since MI?
Cohort study with individual-level linkage of data from national registries.
99 187 patients ≥ 30 years of age (mean age 69 y, 64% men) who were hospitalized with a first MI and alive ≥ 30 days after discharge. 44% of patients had ≥ 1 prescription for NSAIDs.
Filled prescriptions for NSAIDs. Patients were considered at risk from NSAIDs only during periods of exposure to the drugs, and they could contribute exposure time for ≥ 1 drug or ≥ 1 period of use of the same drug. Analyses were adjusted for age, sex, socioeconomic status, concomitant medications, comorbidity index, and year of index hospitalization.
All-cause mortality and a composite endpoint of coronary death or readmission for nonfatal MI.
During follow-up, 37% of patients died, and 29% had a coronary death or nonfatal MI. NSAIDs, other than naproxen, were consistently associated with increased risk for mortality, regardless of time since MI; naproxen was associated with increased risk for mortality at 1 year but not > 5 years after MI (Table). Overall, results were similar for the association of any NSAID with the composite of coronary death or recurrent MI (1 y after MI, hazard ratio [HR] 1.30, 95% CI 1.22 to 1.39; > 5 y after MI, HR 1.41, CI 1.28 to 1.55).
In patients previously hospitalized with a first myocardial infarction, nonsteroidal antiinflammatory drugs were associated with increased risk for mortality, regardless of time since myocardial infarction.
Risk for death associated with NSAID use vs noncurrent NSAID use after hospitalization for a first MI*
*MI = myocardial infarction; NSAID = nonsteroidal antiinflammatory drug.
†Adjusted for age, sex, socioeconomic status, concomitant medications, comorbidity index, and year of index hospitalization.
Belknap SM. NSAIDs were associated with increased risk for mortality, regardless of time since first MI. Ann Intern Med. ;158:JC10. doi: 10.7326/0003-4819-158-2-201301150-02010
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Published: Ann Intern Med. 2013;158(2):JC10.
Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Emergency Medicine, Hospital Medicine.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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