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Common NSAIDs linked with increased MI risk

Common NSAIDs linked with increased MI risk

Publication date: Tuesday, 11 April 2017
Contributor(s): Jeremy Bray

Painkillers considered harmless by the general public are associated with increased risk of cardiac arrest, according to recent research.

The study identified all patients with an out-of-hospital cardiac arrest in Denmark between 2001 and 2010 from the nationwide Danish Cardiac Arrest Registry. Data was collected on all redeemed prescriptions for NSAIDs (including diclofenac, naproxen, ibuprofen, rofecoxib and celecoxib) from Danish pharmacies since 1995.

A case-time-control design was used to examine the association between NSAID use and cardiac arrest. Each patient served as both case and control in two different time periods, eliminating the confounding effect of chronic comorbidities. Use of NSAIDs during the 30 days before cardiac arrest (case period) was compared to use of NSAIDs during a preceding 30 day period without cardiac arrest (control period).

A total of 28,947 patients had an out-of-hospital cardiac arrest in Denmark during the ten year period. Of these, 3376 were treated with an NSAID up to 30 days before the event. Ibuprofen and diclofenac were the most commonly used NSAIDs, making up 51% and 22% of total NSAID use, respectively.

Use of any NSAID was associated with a 31% increased risk of cardiac arrest. Diclofenac and ibuprofen were associated with a 50% and 31% increased risk, respectively (Table). Naproxen, celecoxib and rofecoxib were not associated with the occurrence of cardiac arrest, probably due to a low number of events.
Professor Gunnar H Gislason (Copenhagen University Hospital Gentofte, Denmark) said, “The findings are a stark reminder that NSAIDs are not harmless. NSAIDs should be used with caution and for a valid indication. They should probably be avoided in patients with cardiovascular disease or many cardiovascular risk factors.
 
Table: risk of out-of-hospital cardiac arrest with NSAID use.


Medication

Odds ratio (95% CI)

Diclofenac

1.50 (1.23-1.82)

Ibuprofen

1.31 (1.14-1.51)

Naproxen

1.29 (0.77-2.16)

Celecoxib

1.13 (0.74-1.70)

Rofecoxib

1.28 (0.74-1.70)



ACTION

Use of non-selective NSAIDs is associated with an increased early risk of out of hospital heart attack. Healthcare professionals should be aware of the increased risk of heart attack in ibuprofen and diclofenac users. Professor Gislason recommended taking no more than 1200 mg of ibuprofen per day, or up to 500 mg of naproxen. He said that diclofenac should be avoided by patients with cardiovascular disease and the general population.

Sondergaard K, et al. Non-steroidal anti-inflammatory drug use is associated with increased risk of out-of-hospital cardiac arrest: a nationwide case time control study. Eur Heart J – Cardiovasc Pharmacother2017;3(2):100-7. - academic.oup.com/ehjcvp/article/3/2/100/2739709/Non-steroidal-anti-inflammatory-drug-use-is

 

More details on appropriate use of NSAIDs  are available from NICE - www.nice.org.uk/advice/ktt13/chapter/Evidence-context
Topics covered:
Category: Evidence in Practice
Edition: Volume 2 Number 3 PCCJ Online 2017
Contributor(s): Jeremy Bray

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