Current use of oral NSAIDs was associated with an increased risk of acute myocardial infarction (MI) in a recent systematic review and meta-analysis.
Researchers analyzed four studies that assessed the risk of acute MI in NSAID users versus nonusers, using individual patient data from Canadian and European health care databases. Results were published online on May 9 by The BMJ.
In a total of 446,763 individuals, 61,460 MI events occurred. Compared with nonuse of NSAIDs in the previous year, current use of NSAIDs (at one week, one month, and more than one month) was associated with an increased risk of acute MI. The association was found for all traditional NSAIDs, including naproxen.
For all NSAIDs studied, use of any dose for one to seven days was associated with increased MI risk. Adjusted odds ratios (ORs) were 1.24 (95% CI, 0.91 to 1.82) for celecoxib, 1.48 (95% CI, 1.00 to 2.26) for ibuprofen, 1.50 (95% CI, 1.06 to 2.04) for diclofenac, 1.53 (95% CI, 1.07 to 2.33) for naproxen, and 1.58 (95% CI, 1.07 to 2.17) for rofecoxib.
High NSAID doses were associated with greater risk of MI. Use for eight to 30 days was particularly harmful with more than 1,200 mg of ibuprofen per day (adjusted OR, 1.75; 95% CI, 1.00 to 2.93), more than 750 mg of naproxen per day (adjusted OR, 1.76; 95% CI, 1.14 to 2.65), and more than 25 mg of rofecoxib per day (adjusted OR, 2.65; 95% CI, 1.46 to 4.67). Risk was no greater with more than one month of use compared to shorter durations of use.
The study authors noted limitations of the analysis, such as how the included studies were based on databases and did not measure actual drug consumption. They added that ibuprofen estimates may be more “fragile” because of the drug's universal over-the-counter availability and how as-needed use was more prevalent for ibuprofen than for other NSAIDs.
“Given that the onset of risk of acute myocardial infarction occurred in the first week and appeared greatest in the first month of treatment with higher doses, prescribers should consider weighing the risks and benefits of NSAIDs before instituting treatment, particularly for higher doses,” the authors concluded.