Selective and nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with an increased risk of a first Myocardial Infarction, results of an observational study suggest. Diclofenac and ibuprofen seem to pose about as much risk as the COX-2 inhibitor rofecoxib, the study authors say.
Rofecoxib (Vioxx) was withdrawn from the pharmaceutical market at the end of September 2004 after use of the drug was tied to adverse cardiac effects. Since then, however, questions remain, such as whether all NSAIDs share these harmful effects.
Drs. Julia Hippisley-Cox and Carol Coupland, from the University of Nottingham, UK, conducted a population-based nested case-control study using the QRESEARCH database of information from UK general practices. They report their findings in the June 11th issue of the British Medical Journal.
Their study included 9218 cases of a first MI in people between the ages of 25 and 100 during study period from 2000 to 2004, and 86,349 controls matched by age, calendar time, gender and practice.
The authors identified all prescriptions for NSAIDs for each case and control in the 3 years before their index date (specifically celecoxib, rofecoxib, ibuprofen, diclofenac, naproxen, other selective NSAIDs and other nonselective NSAIDs). Their multivariate analyses adjusted for comorbidities, medications, and other confounders.
"We think that enough concerns exist to warrant a reconsideration of the cardiovascular safety of all NSAIDs," the investigators conclude.
In an associated editorial, Dr. Peter Juni, from University of Berne in Switzerland, and colleagues urge that these data be "interpreted with caution," given that they are observational and other trials have yielded discrepant results.
What is called for now, they contend, are complete meta-analyses, which should "help decision making about issues such as the need for additional trials... to establish the best and safest treatment for patients with musculoskeletal pain."