Effect of Selective Cyclooxygenase 2 Inhibitors and Naproxen on Short-term Risk of Acute Myocardial Infarction in the Elderly

Abstract

The findings of this observational study suggest no increase in the short-term risk of AMI among users of selective cyclooxygenase 2 inhibitors as commonly used in clinical practice. Furthermore, the findings do not support a short-term reduced risk of AMI with naproxen.

Inhibition of Clinical Benefits of Aspirin on First Myocardial Infarction by Nonsteroidal Antiinflammatory Drugs

“…This is particularly true for the relative risks in the placebo and high NSAID-intake group, in which only 1 MI occurred. Although some controversy exists regarding a possible cardioprotective effect of the nonselective NSAID naproxen, [22][23][24][25] an overall cardioprotective effect of NSAIDs is not expected. 9 Another limitation to the generalizability of our findings involves the nature of the cohort, which included only male US physicians, 92% of whom were Caucasian.…”

Relationship between selective cyclooxygenase-2 inhibitors and acute myocardial infarction in older adults

“…6,7 In addition, a recently published observational analysis from Ontario also found no increased risk of AMI associated with any dosage of rofecoxib. 10 This analysis excluded persons who were prescribed a coxib for Ͻ30 days. The findings of our study suggest that the first 30 days of use may include a period of elevated risk.…”

“…9 A smaller observational study found no increased risk of AMI with either coxib, but dosage was not addressed. 10 In 2002, more than 41 million prescriptions were filled in the United States for coxibs, 11 making any potential relationship between coxibs and AMI a substantial clinical and public health issue. We undertook an observational study examining the association between rofecoxib, celecoxib, NSAIDs, and AMI in a large population of older adults for whom complete information was available on prescription medication use and clinical encounters.…”

Colorectal Adenomas

“…However, a recent large retrospective analysis found no increased risk of myocardial infarction among Ͼ15,000 and Ͼ12,000 short-term users of celecoxib and rofecoxib, respectively, over the age of 66 years (109). A meta-analysis of patients in trials of COX-2 inhibitors found an annualized myocardial infarction rate of 0.8 (P ϭ 0.02) and 0.74 (P ϭ 0.04) for celecoxib and rofecoxib, respectively, versus 0.52 for placebo (110).…”