The use of non-steroidal anti-inflammatory drugs (NSAIDs) after myocardial infarction (MI) is associated with an increased risk of cardiovascular and bleeding events, a new study from a large Korean national database shows.
Dong Oh Kang, MD, of Korea University Guro Hospital, Seoul, and colleagues reported their findings in a paper published the study in the Aug. 4 issue of the Journal of the American College of Cardiology.
Currently, there are limited data available regarding the risk of adverse events with NSAIDs use after MI. The authors used data from Korean Health Insurance Review and Assessment Service database and identified 108,322 patients between 2009 and 2013 with a first diagnosed MI. The patients’ mean age was 64 years, and 72% were men. Mean follow-up duration was 2.3±1.8 years. During the follow-up period, about 1.8% of patients were prescribed NSAIDs for at least 4 consecutive weeks. Diclofenac was the most frequently prescribed medication (72% of overall NSAIDs).
Primary cardiovascular events occurred in 24% of patients, and bleeding events happened in 23% of patients. Concomitant NSAID treatment significantly increased the risk of cardiovascular (CV) events (hazard ratio [HR], 6.96; 95% confidence interval [CI], 6.24-6.77; p<0.001) and bleeding events (HR 4.08; 95% CI 3.51-4.73; p<0.001) compared with no NSAID treatment. The risk was highest with dexibuprofen and ibuprofen and was lowest with celecoxib (CV events: HR, 4.65; 95% CI, 3.17-6.82; p<0.001; bleeding events: HR, 3.44; 95% CI, 2.20-5.39; p<0.001) and meloxicam (CV events: HR, 3.03; 95% CI, 1.68-5.47; p<0.001; bleeding events HR, 2.80; 95% CI: 1.40-5.60; p<0.001).
The study further showed that a shorter duration – even a week of concomitant NSAID treatment – increased the risk of these events.
The authors noted several limitations for this analysis, including the study’s observational nature, unmeasured variables, data based on prescription claims and non-availability of mortality outcomes.
The authors concluded that concomitant NSAID treatment significantly increases the risk of CV and bleeding events. The authors suggest the use of celecoxib and meloxicam in cases where NSAID use is unavoidable.
In an accompanying editorial, Juan J. Badimon, PhD, and Carlos G. Santos-Gallego, MD, of the Icahn School of Medicine at Mount Sinai, New York, noted the use of data from 2009 to 2013 as another limitation, because newer medications are now used. Dr. Badimon suggested that if NSAID therapy in patients post-MI is inevitable, it is important for physicians to understand the price paid for pain relief.
“There is no free lunch in medicine, so if NSAID therapy in patients post-MI is inevitable, we have to understand which price we are paying for pain relief,” the editorialists concluded.
Kang DO, An H, Park GU, et al. Cardiovascular and Bleeding Risks Associated with Nonsteroidal Anti-Inflammatory Drugs After Myocardial Infarction. J Am Coll Cardiol 2020;76:518-29. DOI: 10.1016/j.jacc.2020.06.017
Badimon JJ, Santos-Gallego CG. Is Increased Cardiovascular and Bleeding Risk the Price for Pain Relief? No Free Lunch. J Am Coll Cardiol 2020;76:530-2. DOI: 10.1016/j.jacc.2020.06.035