Document Detail


NSAIDs were associated with increased risk for mortality, regardless of time since first MI.
MedLine Citation:
PMID:  23318332     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
QUESTION Does cardiovascular (CV) risk associated with use of nonsteroidal antiinflammatory drugs (NSAIDs) after a first myocardial infarction (MI) differ by time since MI? METHODS DESIGN Cohort study with individual-level linkage of data from national registries. SETTING Denmark. PATIENTS 99 187 patients ≥ 30 years of age (mean age 69 y, 64% men) who were hospitalized with a first MI and alive ≥ 30 days after discharge. 44% of patients had ≥ 1 prescription for NSAIDs. RISK FACTORS Filled prescriptions for NSAIDs. Patients were considered at risk from NSAIDs only during periods of exposure to the drugs, and they could contribute exposure time for ≥ 1 drug or ≥ 1 period of use of the same drug. Analyses were adjusted for age, sex, socioeconomic status, concomitant medications, comorbidity index, and year of index hospitalization. OUTCOMES All-cause mortality and a composite endpoint of coronary death or readmission for nonfatal MI. MAIN RESULTS During follow-up, 37% of patients died, and 29% had a coronary death or nonfatal MI. NSAIDs, other than naproxen, were consistently associated with increased risk for mortality, regardless of time since MI; naproxen was associated with increased risk for mortality at 1 year but not > 5 years after MI (Table). Overall, results were similar for the association of any NSAID with the composite of coronary death or recurrent MI (1 y after MI, hazard ratio [HR] 1.30, 95% CI 1.22 to 1.39; > 5 y after MI, HR 1.41, CI 1.28 to 1.55). CONCLUSION In patients previously hospitalized with a first myocardial infarction, nonsteroidal antiinflammatory drugs were associated with increased risk for mortality, regardless of time since myocardial infarction.Risk for death associated with NSAID use vs noncurrent NSAID use after hospitalization for a first MI*NSAIDPatients prescribed NSAIDsAt 1 y after first MIAt > 5 y after first MIEvents/100 person-yHazard ratio† (95% CI)Events/100 person-yHazard ratio† (CI)All44%20 vs 121.59 (1.49 to 1.69)9.8 vs 6.31.63 (1.52 to 1.74)Ibuprofen27%17 vs 131.42 (1.29 to 1.57)8.8 vs 6.31.55 (1.41 to 1.71)Diclofenac15%25 vs 132.36 (2.07 to 2.68)11 vs 6.42.07 (1.81 to 2.37)Celecoxib3.8%33 vs 131.83 (1.52 to 2.20)18 vs 6.61.68 (1.25 to 2.26)Rofecoxib3.7%31 vs 131.73 (1.43 to 2.10)18 vs 6.61.83 (1.29 to 2.59)Naproxen2.4%20 vs 131.70 (1.27 to 2.27)7.0 vs 6.61.02 (0.70 to 1.47)Other13%19 vs 131.32 (1.16 to 1.50)11 vs 6.41.58 (1.40 to 1.79)*MI = myocardial infarction; NSAID = nonsteroidal antiinflammatory drug.†Adjusted for age, sex, socioeconomic status, concomitant medications, comorbidity index, and year of index hospitalization.
Authors:
Steven M Belknap
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of internal medicine     Volume:  158     ISSN:  1539-3704     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  JC10     Citation Subset:  AIM; IM    
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