NSAID heart risk starts early


New research has confirmed a link between NSAIDs and the risk of acute myocardial infarction – with increased risk on immediate exposure to the anti-inflammatory medications.

The meta-analysis of almost 500,000 individuals including 61,460 with acute MI found an increase in risk from both traditional NSAIDs and COX-2 inhibitors within the first week.

The odds ratio for MI ranged from celecoxib (1.24), ibuprofen (1.48) diclofenac (1.50), and naproxen (1.53) to rofecoxib (1.58), and was dose-dependent.

“Short term use for 8-30 days at a high daily dose (celecoxib >200 mg, diclofenac >100 mg, ibuprofen >1200 mg, and naproxen >750mg) is associated with the greatest harms, without obvious further increases in risk beyond the first 30 days,” said the authors of the study published in The BMJ.

Professor Danny Liew, co-director of the Monash Centre of Cardiovascular Research and Education in Therapeutics, told the limbic the findings confirm and add to the body of evidence for elevated risk of MI with NSAIDs.

“The important thing for people to realise is that the increase in relative risk of MI might be within the initial period of use.”

“We already have an understanding of their limited role from a safety point of view. The potential for adverse effects from these drugs is not disputed in terms of bleeding, GI ulceration and fluid excess. This is yet another thing to consider when determining risk versus benefit.”

However the increased risk had to be kept in perspective when considering each patient’s individual risk.

“For example, in terms of celecoxib, a 24% increase in relative risk for someone with a low risk of MI won’t translate into a real risk,” Professor Liew said.

Young, fit people requiring short term-relief from pain with an inflammatory component would not be at significant risk of MI.  However NSAIDs should not be used long-term for chronic pain or in the elderly and people with conditions such as heart failure or significant hypertension.

Professor John McNeil, head of the School of Public Health & Preventive Medicine at Monash University, said NSAIDs can provide substantial relief and the trade off against a relatively small risk of heart disease may well be worth taking

“The longstanding advice to take the lowest effective dose for the shortest time is sound, especially in those whose risk of heart disease is already high. There was no substantial difference in risk between any of the commonly used NSAIDS,” he said.

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