Use of both traditional NSAIDs and COX-2 inhibitors has previously been linked to an increased risk of stroke and other vascular events (Arch Intern Med 2008 Jun 9;168(11):1219, BMJ 2006 Jun 3;332(7553):1302). For patients with cardiovascular disease, current guidelines recommend NSAIDs for pain relief only in patients for whom there are no alternatives and only at the lowest doses and durations necessary (Circulation 2007 Mar 27;115(12):1634). A recent nationwide cohort study in Denmark suggests that any NSAID use may increase the risk of death or recurrent myocardial infarction (MI) in patients with a previous MI (level 2 [mid-level] evidence). Prescription NSAID use was assessed through records from a national registry for 83,677 patients (mean age 68 years) who were hospitalized with a first MI from 1997 to 2006. During the study period, a total of 42.3% of patients received an NSAID prescription, most commonly ibuprofen (23%) or diclofenac (13.4%), and 35,257 patients either died or had another MI. In analyses stratified by treatment duration, the risk of death or recurrent MI during NSAID treatment was significantly increased at all time points from < 1 week of treatment to > 3 months. Hazard ratios ranged from 1.45 (95% CI 1.29-1.62) to 1.68 (95% CI 1.5-1.88). Individual drugs were associated with increased risk at most time points in subgroup analyses. Risk was increased at all time points for diclofenac, and was highest for < 1 week of use (hazard ratio 3.26, 95% CI 2.75-3.86) (Circulation 2011 May 9 early online).
For more information, see the COX-2 inhibitors and NSAIDs for rheumatoid arthritis topics in DynaMed.