Cause-specific cardiovascular risk associated with nonsteroidal anti-inflammatory drugs among myocardial infarction patients--a nationwide study

Non steroidal anti-inflammatory drugs (NSAIDs) increase mortality and morbidity after myocardial infarction (MI). We examined cause-specific mortality and morbidity associated with NSAIDs in a nationwide cohort of MI patients. By individual-level linkage of nationwide registries of hospitalization a...

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Bibliographic Details
Published in:PloS one 2013-01, Vol.8 (1), p.e54309
Main Authors: Olsen, Anne-Marie Schjerning, Fosbøl, Emil L, Lindhardsen, Jesper, Andersson, Charlotte, Folke, Fredrik, Nielsen, Mia B, Køber, Lars, Hansen, Peter R, Torp-Pedersen, Christian, Gislason, Gunnar H
Format: Article
Language:English
Subjects:
Aged
Anti-inflammatory agents
Anti-Inflammatory Agents, Non-Steroidal - administration & dosage
Anti-Inflammatory Agents, Non-Steroidal - adverse effects
Cardiac patients
Cardiovascular disease
Cardiovascular diseases
Cerebral infarction
Confidence intervals
COX-2 inhibitors
Cyclooxygenase-2
Death
Denmark
Diclofenac
Diclofenac - administration & dosage
Diclofenac - adverse effects
Drug therapy
Drugs
Female
Follow-Up Studies
Health aspects
Health risk assessment
Health risks
Heart attack
Hospitalization
Humans
Ibuprofen
Inflammation
Lactones - administration & dosage
Lactones - adverse effects
Male
Medical research
Medicine
Middle Aged
Morbidity
Mortality
Myocardial infarction
Myocardial Infarction - drug therapy
Myocardial Infarction - mortality
Myocardial Infarction - pathology
Naproxen
Nonsteroidal anti-inflammatory drugs
Patients
Pharmacy
Proportional Hazards Models
Registries
Risk Factors
Rofecoxib
Socioeconomic factors
Sulfones - administration & dosage
Sulfones - adverse effects
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Summary:Non steroidal anti-inflammatory drugs (NSAIDs) increase mortality and morbidity after myocardial infarction (MI). We examined cause-specific mortality and morbidity associated with NSAIDs in a nationwide cohort of MI patients. By individual-level linkage of nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark, patients aged >30 years admitted with first-time MI during 1997-2009 and their subsequent NSAID use were identified. The risk of three cardiovascular specific endpoints: cardiovascular death, the composite of coronary death and nonfatal MI, and the composite of fatal and nonfatal stroke, associated with NSAID use was analyzed by Cox proportional hazard analyses. Of 97,698 patients included 44.0% received NSAIDs during follow-up. Overall use of NSAIDs was associated with an increased risk of cardiovascular death (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.36-1.49). In particular use of the nonselective NSAID diclofenac and the selective cyclooxygenase-2 inhibitor rofecoxib was associated with increased risk of cardiovascular death (HR 1.96 [1.79-2.15] and HR1.66 [1.44-1.91], respectively) with a dose dependent increase in risk. Use of ibuprofen was associated with increased risk of cardiovascular death (HR 1.34[1.26-1.44]), whereas naproxen was associated with the lowest risk of (e.g., HR 1.27[1.01-1.59]. Use of individual NSAIDs is associated with different cause-specific cardiovascular risk and in particular rofecoxib and diclofenac were associated with increased cardiovascular morbidity and mortality. These results support caution with use of all NSAIDs in patients with prior MI.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0054309