Use of nonsteroidal anti-inflammatory drugs and the risk of first-time acute myocardial infarction

Authors

  • Raymond G. Schlienger,

    1. Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacology and Toxicology, University Hospital, Basel, Switzerland and
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  • Hershel Jick,

    1. Boston Collaborative Drug Surveillance Program, Boston University Medical Center, Lexington, MA, USA
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  • Christoph R. Meier

    1. Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacology and Toxicology, University Hospital, Basel, Switzerland and
    2. Boston Collaborative Drug Surveillance Program, Boston University Medical Center, Lexington, MA, USA
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Christoph R. Meier, PhD, M.Sc., Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacology and Toxicology, University Hospital of Basel, Petersgraben 4, CH −4031 Basel, Switzerland. Tel: + 41 61 265 88 70; Fax: + 41 61 265 88 64; E-mail: Christoph.Meier@unibas.ch

Abstract

Aims Aspirin decreases the risk of clinical manifestations of atherothrombosis. This effect is mainly due to inhibition of platelet aggregation and potentially due to anti-inflammatory properties of aspirin. To evaluate whether use of non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) may also be associated with a decreased risk of first-time acute myocardial infarction (AMI), we performed a population-based case-control analysis using the United Kingdom-based General Practice Research Database (GPRD)

Methods We identified first-time AMI-patients free of preexisting diagnosed cardiovascular or metabolic diseases. We compared use of NSAIDs prior to the index date between cases and control patients who were matched to cases on age, gender, practice and calendar time.

Results A total of 3319 cases (≤75 years) with a diagnosis of first-time AMI between 1992 and 1997 and 13139 controls (matched to cases on age, sex, general practice attended, calendar time, years of prior history in the GPRD) were included. Overall, the relative risk estimate of AMI (adjusted for smoking, body mass index, hormone replacement therapy and aspirin) in current NSAID users was 1.17 (95% CI 0.99, 1.37). Long-term current NSAID use (≥30 prescriptions) yielded an adjusted odds ratio (OR) of 1.20 (95% CI 0.94, 1.55). Stratification by age (<65 years vs≥65 years) and sex did not materially change the results.

Conclusions Our findings indicate that current NSAID exposure in patients free of diagnosed cardiovascular or metabolic conditions predisposing to cardiovascular diseases does not decrease the risk of AMI.

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