All non-steroidal anti-inflammatory drugs may carry an increased risk of acute myocardial infarction, researchers say today.
This applies particularly during the first month of use and with higher doses, according to the Canadian analysts.
Dr Michele Bally of the University of Montreal Hospital Research Center, Canada, and colleagues say it is generally accepted that oral non-steroidal anti-inflammatory drugs can increase the risk of acute myocardial infarction, or heart attack.
Previous studies on the link "have been of limited use for assessing this rare adverse event", say the authors in today’s (10 May) BMJ, "as they had small cohorts and poor generalisability."
The trials also excluded those at highest cardiovascular risk or with established cardiovascular disease.
So the team carried out a systematic review and a meta-analysis of patient information, covering 446,763 people from healthcare databases including those from Canada, Finland and the UK, of whom 61,460 suffered acute myocardial infarction.
This showed that: "Taking any dose of non-steroidal anti-inflammatory drug for one week, one month, or more than a month was associated with an increased risk of myocardial infarction."
This applied to both traditional and COX 2 selective non-steroidal anti-inflammatory drugs. Using the drugs for one to seven days raised the risk by 24% for the drug celecoxib, 48% for ibuprofen, 50% for diclofenac, 53% for naproxen, and 58% for rofecoxib, compared with not using these drugs.
The authors conclude that the risk of myocardial infarction with celecoxib was comparable to that of traditional non-steroidal anti-inflammatory drugs. They add that risk was greatest during the first month of use and with higher doses.
The UK Royal College of GPs said the use of NSAIDs was reducing in general practice.
Chair Professor Helen Stokes-Lampard said: “We know that what works best – and this is supported by the latest NICE guidelines – for treating many cases of chronic pain is a combination of therapies, be these physical, psychological or pharmacological.
"It is vital that GPs have adequate access to a variety of therapies in the community, so that we can develop a treatment plan for our patients living with chronic pain that works best for them.”
She added: “This study builds on research highlighting the risks involved in using NSAIDs, such as ibuprofen, to treat pain – and it’s important that as new research is published, it is taken on board to inform the clinical guidelines that support our work.
"This study should also raise awareness amongst patients who self-medicate with NSAIDs that are available over the counter, to treat their pain."
Bally, M. et al. Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ 10 May 2017; doi: 10.1136/bmj.j1909 [abstract]
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