A meta-analysis published in the British Medical Journal has shown that the oral nonsteroidal anti-inflammatory drug (NSAID) use is associated with an increased risk of acute myocardial infarction (MI).
The cardiovascular safety of NSAIDs is an issue of major interest for clinicians who treat patients especially with rheumatic diseases. In a new study, the Bayesian meta-analysis of individual patient data included 446,763 individuals from Canada and Europe, 61,460 of whom had an MI. The drugs studied were the traditional NSAIDs diclofenac, ibuprofen, and naproxen, and the cyclooxygenase 2-selective NSAIDs celecoxib and rofecoxib.
Investigators found that all NSAIDs — including naproxen, which had previously been thought to have superior cardiovascular safety — are associated with an increased risk of MI. The risk was greatest during the first month of NSAID use and with higher doses. With prolonged use of NSAIDs, the risk of MI remained constantly elevated, but did not seem to increase further; however, data on the risk of a second MI were not available.
The researchers conclude that prescribers should consider weighing the risks and benefits of NSAIDs before instituting treatment, particularly for higher doses. Additional studies should focus on the ideal dose of NSAIDs that yields arthritic pain relief without a further increase in the risk of cardiovascular events in these patients.