Most NSAIDs unsafe for patients with prior MI

There is no safe therapeutic window of time for using nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with prior myocardial infaction (MI). Even short-term treatment with most NSAIDs appears associated with increased risk of death and recurrent MI. In general, NSAIDs should be limited from a cardiovascular safety point of view, according to a study published in Circulation.

To analyze the risk of death and recurrent MI according to duration of NSAID treatment, investigators identified a population of patients in the Danish National Patient Registry with first-time admission for MI (ICD-10, I21 through I22) from January 1, 1997, to December 31, 2006, and no prior admission for MI in the previous 19 years.

Of the 83,677 patients included, 42.3% received NSAIDs during follow-up. The most commonly used NSAIDs were ibuprofen (23.2%) and diclofenac (13.4%); the most commonly used selective cyclooxygenase-2 (COX-2) inhibitors were rofecoxib (4.7%) and celecoxib (4.8%). Overall NSAID treatment was significantly associated with an increased risk of death/recurrent MI at the beginning of the treatment, and the risk persisted throughout the course of treatment.

Diclofenac was associated with the highest risk (HR, 3.26; 95% CI, 2.57 to 3.86 for death/MI at day 1 to 7 of treatment), and the risk persisted throughout the course of treatment. Ibuprofen was associated with an increased risk when used for more than 1 week; however the risk was lower than the risk with the COX-2 selective inhibitors and diclofenac. Rofecoxib was associated with increased risk of death after a treatment range of 7 to 14 days, and celecoxib was associated with increased risk of death after a treatment range of 14 to 30 days. Naproxen was not associated with an increased risk of death or MI for the entire treatment duration.

“These results challenge the view that NSAIDs are not harmful during short-term (1 week) treatment and indicate that a revision of current recommendations regarding NSAID treatment in patients with established cardiovascular disease is required,” the authors wrote.