Montreal—Even in the first month of use, patients taking nonsteroidal anti-inflammatory drugs (NSAIDs) to treat pain and inflammation are at higher risk of acute myocardial infarction (AMI), a new study reveals.
In fact, the report in The BMJ said the increased likelihood begins to spike as early as the first week of use and continues for the first month of taking high dosages of NSAIDs.
Based on their results, a study team lead by researchers from the University of Montreal Hospital Research Center urges prescribers to carefully balance the risks and benefits of ibuprofen, diclofenac, celecoxib, and naproxen before recommending them.
While past studies have linked an increased AMI risk with both traditional and COX-2-selective NSAIDs, the timing of the risk, the effect of dose, treatment duration, and the comparative risks between NSAIDs were poorly understood.
For the study, researchers conducted a systematic review and a meta-analysis of relevant studies from various healthcare databases, including those from Canada, Finland, and the United Kingdom, focusing on 446,763 patients, 61,460 of whom had a heart attack.
Information was gathered on the effects of celecoxib, the three main traditional NSAIDs—diclofenac, ibuprofen, and naproxen—and rofecoxib.
Results indicate that taking any dose of NSAIDs for 1 week, 1 month, or more than a month was associated with an increased risk of AMI. Unlike some past studies, naproxen was associated with the same risk of heart attack as that established for other NSAIDs. With celecoxib, the risk was lower than that for rofecoxib, but was comparable to that of traditional NSAIDs.
The increase in risk of AMI was calculated as about 20% to 50% when comparing those using NSAIDs with others not on the drugs. That means the risk of heart attack due to NSAIDs is about 1% annually, on average, the report notes.
Based on further analysis, the researchers determined that AMI risk rose with higher doses and was greatest during the first month of use. The risk did not appear to climb with longer term use, but study authors still suggest NSAIDs be administered for as short a time as possible.
“Given that the onset of risk of acute myocardial infarction occurred in the first week and appeared greatest in the first month of treatment with higher doses, prescribers should consider weighing the risks and benefits of NSAIDs before instituting treatment, particularly for higher doses,” they conclude.
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