It is well established that non-steroidal anti-inflammatory drugs (NSAIDs) are associated with an increased risk of cardiovascular events including myocardial infarction. A recently published meta-analysis provides further data on the degree of this risk in relation to the timing of doses for different NSAIDs.
This study suggests that selective and non-selective NSAIDs increase the risk of acute myocardial infarction, particularly with high doses. The NSAIDs studied, in order of increasing odds ratios, were celecoxib (1.24), ibuprofen (1.48), diclofenac (1.50), naproxen (1.53), and rofecoxib (1.58). Results demonstrate that increased risk occurs during the first week of therapy, yet does not continue to increase when the duration of therapy exceeds 30 days.
The study authors conclude that these findings, based on over 446,000 individuals, may be broadly generalisable. Their key recommendations are to weigh the risks and benefits of initiating NSAID treatment, especially when high doses are required.
As a class, NSAIDs are valuable non-addictive analgesics. While this study demonstrates a significantly increased relative risk of myocardial infarction, this may not be clinically significant in patients with a low background risk. However, due to the widespread use of these agents, the Therapeutic Goods Administration (TGA) advises that even a small absolute risk could translate into a significant health burden. Alternative strategies to manage pain and inflammation may be appropriate, particularly in high-risk patients.
- Bally M, Dendukuri N, Rich B, Nadeau L, Helin-Salmivaara A, Garbe E, et al. Risk of acute myocardial infarction with NSAIDs in real world use: Bayesian meta-analysis of individual patient data. BMJ. 2017; 357: j1909.
- Department of Health. Review of cardiovascular safety of non-steroidal anti-inflammatory drugs. Woden: Therapeutic Goods Administration, 2014.