Cardiovascular Risks of Nonsteroidal Antiinflammatory Drugs in Patients After Hospitalization for Serious Coronary Heart Disease

Authors:
  • CVCristina Varas-Lorenzo
    Cristina Varas-Lorenzo
  • CCCecilia P. Chung
    Cecilia P. Chung
  • JCJordi Castellsague
    Jordi Castellsague
  • KMKatherine T. Murray
    Katherine T. Murray
  • CSC. Michael Stein
    C. Michael Stein
  • JDJames R. Daugherty
    James R. Daugherty
  • PAPatrick G. Arbogast
    Patrick G. Arbogast
  • LGLuis A. García-RodrígUez
    Luis A. García-RodrígUez
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Abstract
Background— The cardiovascular safety of individual nonsteroidal antiinflammatory drugs (NSAIDs) is highly controversial, particularly in persons with serious coronary heart disease. Methods and Results— We conducted a multisite retrospective cohort study of commonly used individual NSAIDs in Tennessee Medicaid, Saskatchewan Health, and United Kingdom General Practice Research databases. The cohort included 48566 patients recently hospitalized for myocardial infarction, revascularization, or unstable angina pectoris with more than 111000 person-years of follow-up. Naproxen users had the lowest adjusted rates of serious coronary heart disease (myocardial infarction, coronary heart disease death) and serious cardiovascular disease (myocardial infarction, stroke)/death from any cause, with respective incidence rate ratios (relative to NSAID nonusers) of 0.88 (95% CI, 0.66 to 1.17) and 0.91 (0.78 to 1.06). Risk did not increase with doses ≥1000 mg. Relative to NSAID nonusers, serious coronary heart disease risk increased with short term (25 mg (2.29 [1.24 to 4.22], P =0.008) and celecoxib >200 mg (1.61 [1.01 to 2.57], P =0.046). Conclusions— In patients recently hospitalized for serious coronary heart disease, naproxen had better cardiovascular safety than did diclofenac, ibuprofen, and higher doses of celecoxib and rofecoxib.

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