Does the varied use of NSAIDs explain the differences in the risk of myocardial infarction?

Abstract

Abstract. van Staa T-P, Rietbrock S, Setakis E, Leufkens HGM (Medicines and Healthcare Products Regulatory Agency, London, UK; Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands). Does the varied use of NSAIDs explain the differences in the risk of myocardial infarction? J Intern Med 2008; 264: 481-492.Objective. To investigate the risk of myocardial infarction (MI) with diclofenac, ibuprofen and naproxen, taking into account the exposure patterns.Design. Retrospective cohort study using the General Practice Research Database.Setting. UK primary care. Subjects. Patients aged 40+ years prescribed a traditional nonsteroidal anti-inflammatory drug (NSAID).The control cohort was frequency matched by disease risk score.Intervention. Observational comparisons of MI rates.Results. The study included 729294 NSAID users and 443047 controls. The relative rate (RR) for MI increased with cumulative and daily dose (RR = 1.05 with 0-4 prior prescriptions and RR = 1.49 with 30+; RR = 1.05 with daily dose of <1200 mg ibuprofen and RR = 1.96 with dose of ‡2400 mg per day; for diclofenac, the RR was 1.13 with <150 mg per day and 2.03 with ‡300 mg per day). Diclofenac users had higher risks of MI (RR = 1.21) than ibuprofen (RR = 1.04) or naproxen (RR = 1.03) users, but exposure varied between these drugs. Taking into account these exposure differences, it was found that the risk of MI was comparable in current and past long-term users. The patterns of hazard rates (i.e. absolute risks) of MI were similar in patients using ibuprofen, diclofenac or naproxen with similar history of NSAID use. There was no statistical difference between ibuprofen, diclofenac and ibuprofen in the linear trends for cumulative dose or daily dose.Conclusions. Long-term users of traditional NSAIDs have an increased risk of MI that is probably explained by the underlying disease severity. Most of the differences in MI risk between diclofenac, ibuprofen or naproxen may be explained by their varied use.

Utilization Pattern of Non-steroidal Anti-inflammatory Drugs at a Primary Health Care in Malaysia

“…5,8 In many reported cases, the gastrointestinal (GI) complications related to NSAIDs use was four times higher when compared to non-users. 9,10 Furthermore, findings of the current study has also indicated that patients on medications for management of chronic underlying illness are among the frequent users of NSAIDs. Up to 22.9% of the NSAIDs users were on antihypertensive medications, even though, the figure is less than the previously reported estimate of 61%.…”

All‐cause mortality of elderly Australian veterans using COX‐2 selective or non‐selective NSAIDs: a longitudinal study

“…The literature about NSAIDs is often contradictory, particularly about celecoxib, where the dose may be important. Increased risk of myocardial infarction and death with celecoxib and other non-selective NSAIDs has been found in large, well-designed epidemiological studies [11,19,20] as well as under clinical trial conditions [6]. It may also be relevant that, in contrast to some other studies, our cohort population was elderly with multiple co-morbidities assessed by co-prescription surrogates: 70% had at least one cardiovascular risk factor, 23% had two and 3.03% had three or more risk factors.…”

A Review on different types of the Non Steroidal Anti-Inflammatory Drugs (NSAIDs)

“…(24,25)  The substituent on the nitrogen atom which reduces basicity also reduces activity except for acetyl which is metabolically labile. (26,27) Clinical uses:…”