Healthy Skepticism Library item: 6348

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Publication type: Journal Article

Jick H, Kaye JA, Russmann S, Jick SS.
Nonsteroidal antiinflammatory drugs and acute myocardial infarction in patients with no major risk factors
Pharmacotherapy. 2006 Oct 1; 26:(10):1379-87

Abstract:

STUDY OBJECTIVE: To assess the risk of long-term use of five
nonsteroidal antiinflammatory drugs (NSAIDs)—rofecoxib, celecoxib,
ibuprofen, naproxen, and diclofenac—in relation to acute myocardial
infarction. DESIGN: Five separate nested case-control studies, one for each
NSAID, designed to minimize important biases present in other observational
studies. Setting. University-affiliated research program. Data Source. The
United Kingdom General Practice Research Database (GPRD). MEASUREMENTS AND
MAIN RESULTS: We identified all people in the GPRD aged 30-79 years who had
a first recorded prescription for rofecoxib, celecoxib, ibuprofen, naproxen,
or diclofenac after January 1, 1999. Cases of newly diagnosed, first-time
acute myocardial infarction were then identified from the study population,
along with matched control subjects. Relative risk estimates for acute
myocardial infarction in patients with no recorded major clinical risk
factors for acute myocardial infarction were determined for each NSAID
according to receipt of 2-4, 5-9, 10-19, or 20 or more prescriptions
compared with receipt of only 1 prescription. Results were adjusted for
relevant variables possibly related to the risk for acute myocardial
infarction. No material elevation of risk according to the number of
prescriptions received for ibuprofen or naproxen was noted. However, a
substantial increased risk similar to that found in clinical trials was
noted in patients who received 10 or more prescriptions for rofecoxib,
celecoxib, or diclofenac. CONCLUSION: Extensive use of rofecoxib, celecoxib,
and diclofenac increases the risk of acute myocardial infarction, but
similar use of ibuprofen and naproxen does not.