Long-Term Cardiovascular Risk of NSAID Use According to Time Passed After First-Time Myocardial Infarction: A Nationwide Cohort Study
Background—The cardiovascular risk after the first myocardial infarction (MI) declines rapidly during the first year. We analyzed whether the cardiovascular risk associated with using nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with the time elapsed following first-time MI.
Methods and Results—We identified patients aged 30 years or older admitted with first-time MI in 1997-2009 and subsequent NSAID use by individual-level linkage of nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark. We calculated the incidence rates of death and a composite endpoint of coronary death or nonfatal recurrent MIs associated with NSAID use in 1-year time intervals up to 5 years after inclusion and analyzed risk by using multivariable adjusted time-dependent Cox proportional-hazard models. Of the 99,187 patients included, 43,608 (44%) were prescribed NSAIDs after the index MI. There were 36,747 deaths and 28,693 coronary deaths or nonfatal recurrent MIs during the 5 years of follow-up. Relative to non-current treatment with NSAIDs, the use of any NSAID in the years following MI was persistently associated with an increased risk of death (hazard ratio (HR) 1.59 (95% confidence interval (CI) 1.49-1.69) after 1 year and HR 1.63 (CI 1.52-1.74) after 5 years) and coronary death or nonfatal recurrent MI (HR 1.30 (CI 1.22-1.39) and HR 1.41 (CI 1.28-1.55).
Conclusions—The use of NSAIDs is associated with persistently increased coronary risk regardless of time elapsed after first-time MI. We advise long-term caution in using NSAIDs for patients after MI.
- myocardial infarction
- non-steroidal anti-inflammatory drugs (NSAIDs)
- selective cyclooxygenase (COX)-2 inhibitors
- Received April 17, 2012.
- Accepted July 19, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited