NSAIDs associated with increased cardiovascular risk up to five years post-MI

Taking NSAIDs increases cardiovascular risk for heart attack survivors as long as five years after the attack, a new study found.

The observational study used data on about 100,000 Danish patients hospitalized with a first-time myocardial infarction (MI) between 1997 and 2009. Their use of nonsteroidal anti-inflammatory drugs (NSAIDs) over the following five years was determined from pharmacy registries. Results were published by Circulation on Sept. 10.

Overall, 44% of the patients were prescribed NSAIDs at some point in the five years following MI. There were 36,747 deaths and 28,603 coronary deaths or nonfatal MIs among the whole study population during that period. Researchers found that patients taking an NSAID, compared to those who didn't, had a similarly increased risk of death at one year after MI (hazard ratio [HR], 1.59; 95% CI, 1.49-1.69) and at five years out (HR, 1.63; 95% CI, 1.52-1.74). They also had a higher risk of coronary death or nonfatal MI after one year (HR, 1.30; 95% CI, 1.22-1.39) and five years (HR, 1.41; 95% CI, 1.28-1.55).

Researchers concluded that taking NSAIDs was associated with an increased cardiovascular risk for these patients, regardless of the time elapsed since their MI. “It would seem prudent to limit NSAID use among patients with cardiovascular disease and to get the message out to clinicians taking care of these patients that NSAIDs are potentially harmful,” they wrote.

Naproxen was associated with the lowest cardiovascular risk in the study, suggesting it might be the preferred NSAID if treatment cannot be avoided, the authors said. However, gastrointestinal bleeding is an additional risk with that drug. The authors called for additional research into the cardiovascular effects of NSAIDs but suggested that in the meantime, the drugs should be avoided or used cautiously in all patients who have had an MI.