Document Detail

Long-term cardiovascular risk of nonsteroidal anti-inflammatory drug use according to time passed after first-time myocardial infarction: a nationwide cohort study.
MedLine Citation:
PMID:  22965337     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The cardiovascular risk after the first myocardial infarction (MI) declines rapidly during the first year. We analyzed whether the cardiovascular risk associated with using nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with the time elapsed following first-time MI.
METHODS AND RESULTS: We identified patients aged 30 years or older admitted with first-time MI in 1997 to 2009 and subsequent NSAID use by individual-level linkage of nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark. We calculated the incidence rates of death and a composite end point of coronary death or nonfatal recurrent MIs associated with NSAID use in 1-year time intervals up to 5 years after inclusion and analyzed risk by using multivariable adjusted time-dependent Cox proportional hazards models. Of the 99 187 patients included, 43 608 (44%) were prescribed NSAIDs after the index MI. There were 36 747 deaths and 28 693 coronary deaths or nonfatal recurrent MIs during the 5 years of follow-up. Relative to noncurrent treatment with NSAIDs, the use of any NSAID in the years following MI was persistently associated with an increased risk of death (hazard ratio 1.59 [95% confidence interval, 1.49-1.69]) after 1 year and hazard ratio 1.63 [95% confidence interval, 1.52-1.74] after 5 years) and coronary death or nonfatal recurrent MI (hazard ratio, 1.30 [95% confidence interval,l 1.22-1.39] and hazard ratio, 1.41 [95% confidence interval, 1.28-1.55]).
CONCLUSIONS: The use of NSAIDs is associated with persistently increased coronary risk regardless of time elapsed after first-time MI. We advise long-term caution in the use of NSAIDs for patients after MI.
Anne-Marie Schjerning Olsen; Emil L Fosbøl; Jesper Lindhardsen; Fredrik Folke; Mette Charlot; Christian Selmer; Jonas Bjerring Olesen; Morten Lamberts; Martin H Ruwald; Lars Køber; Peter R Hansen; Christian Torp-Pedersen; Gunnar H Gislason
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-09-10
Journal Detail:
Title:  Circulation     Volume:  126     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-16     Completed Date:  2012-12-31     Revised Date:  2013-08-12    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1955-63     Citation Subset:  AIM; IM    
Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
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MeSH Terms
Aged, 80 and over
Anti-Inflammatory Agents, Non-Steroidal / administration & dosage,  adverse effects*,  contraindications
Cohort Studies
Death, Sudden, Cardiac / epidemiology*
Denmark / epidemiology
Follow-Up Studies
Hospitalization / statistics & numerical data
Middle Aged
Myocardial Infarction / mortality*
Pharmacy / statistics & numerical data
Proportional Hazards Models
Registries / statistics & numerical data*
Risk Factors
Reg. No./Substance:
0/Anti-Inflammatory Agents, Non-Steroidal
Comment In:
Ann Intern Med. 2013 Jun 18;158(12):903-6   [PMID:  23580081 ]
Ann Intern Med. 2013 Jan 15;158(2):JC10   [PMID:  23318332 ]

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