Heart risk raised in women regularly using NSAIDs

Women who are regular users of non-steroidal anti-inflammatory drugs (NSAIDs) should be aware that these medications may increase the risk of adverse cardiovascular events, according to a study published in the July issue of Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

“We found that regular use of NSAIDs was associated with an increased risk of cardiovascular death, myocardial infarction [MI], or stroke among postmenopausal women,” said lead author Anthony Bavry, MD, MPH, Interventional Cardiology, Malcom Randall VA Medical Center, associate professor of medicine, University of Florida, Gainesville. “Moreover, this risk was observed among selective cox-2 inhibitors and the non-selective NSAID naproxen, but not ibuprofen.”

The cardiovascular toxicity of NSAIDs is not well known, especially among women, according to Dr Bavry.

Dr Bavry and colleagues conducted an observational study conducted from approximately 160,000 postmenopausal women from the Women’s Health Initiative classified as regular users or nonusers of nonaspirin NSAIDs. Cox regression examined NSAID use as a time-varying covariate and its association with the primary outcome of total cardiovascular disease defined as cardiovascular death, nonfatal MI, or nonfatal stroke, according to the study.

“Secondary analyses considered the association of selective cox-2 inhibitors (eg, celecoxib), nonselective agents with cox-2>cox-1 inhibition (eg, naproxen), and nonselective agents with cox-1>cox-2 inhibition (eg, ibuprofen) with the primary outcome,” the authors wrote.

Regular NSAID use at some point in time was reported by 53,142 participants.

“Regular NSAID use was associated with an increased hazard for cardiovascular events versus no NSAID use,” the authors wrote. “Selective cox-2 inhibitors were associated with a modest increased hazard for cardiovascular events. Among aspirin users, concomitant selective cox-2 inhibitor use was no longer associated with increased hazard for cardiovascular events. There was an increased risk for agents with cox-2>cox-1 inhibition. This harmful association remained among concomitant aspirin users.”

The authors did not observe a risk elevation for agents with cox-1>cox-2 inhibition.

“Women who are regular users of NSAIDs should discuss the use of this medication with their provider,” Dr Bavry said. “The use of these medications needs to be individualized between patient and provider.”