Abstract 5009: Exposure Time And Cardiovascular Risk Of NSAID Treatment In Patients With Acute Myocardial Infarction Or Heart Failure
To analyze the effect of duration of exposure to NSAID treatment on cardiovascular risk in two separate patient-populations of patients with previous acute myocardial infarction (MI) or diagnosis of heart failure (HF). Two cohorts of patients discharged after first hospitalization for MI or HF and their subsequent use of NSAIDs were identified by individual-level-linkage of nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark. Risk of death according to duration of NSAID treatment exposure was analyzed by time-dependent Cox proportional-hazard models. Two cohorts of 58,432 patients with MI and 107,092 patients with HF were included in the study. Respectively 36% and 34% of patients with MI and HF claimed at least one NSAID prescription after discharge. Results of the Cox regression analysis for both cohorts demonstrated increased risk of death after only 7 days from initiation of treatment and the highest risk during the first 90 days (Figure⇓). This applied for both the selective COX-2 inhibitors and non-selective NSAIDs, but for diclofenac the risk was immediately increased from treatment initiation. The increased risk of death associated with NSAID treatment is apparent after only 7 days of treatment in patients with established cardiovascular disease. Diclofenac appears to be associated with an increased risk immediately after initiation of treatment. This underscores the importance of careful consideration of the balance between risk and benefits before initiation of any NSAID therapy in all patients with cardiovascular disease.