A new study led by researchers at the University of Montreal has found that the risk of myocardial infarction (MI) associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) can increase as early as one week after starting the medications. The results were published in the British Medical Journal.
In a systematic review of Canadian and European health care databases, the authors found that taking any dose of NSAIDs for one week, one month, or more than one month was associated with an increased risk of MI among 61,460 cases of acute MI.
With NSAID use for one to seven days, the probability of an increased risk of MI was 92% for celecoxib, 97% for ibuprofen, and 99% for diclofenac, naproxen, and rofecoxib. The corresponding odds ratios were 1.24 (range, 0.91 to 1.82) for celecoxib; 1.48 (1.00 to 2.26) for ibuprofen; 1.50 (1.06 to 2.04) for diclofenac; 1.53 (1.07 to 2.33) for naproxen; and 1.58 (1.07 to 2.17) for rofecoxib. A greater risk of MI was documented for higher NSAID doses.
Overall, NSAIDs exhibited a rapid onset of risk for MI during the first week of use, the authors concluded. The use of high doses of ibuprofen (greater than 1,200 mg/day), naproxen (greater than 750 mg/day), or rofecoxib (greater than 25 mg/day) for eight to 30 days was particularly harmful.
Lead author Dr. Michèle Bally told The New York Times that the absolute increase in MI risk was quite small, since the risk of heart attack for most people is small to begin with.
Still, she said, “I want people to have a conversation with their doctor. People are often not aware of their own baseline cardiovascular risk. You may want to stay with NSAIDs, or you may want to consider other treatments.”
In any case, she added, “Read the label and use the lowest possible effective dose.”