CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

May 10th, 2011

Short-Term NSAID Use Linked to Increased CV Risk

Short-term use of NSAIDs, including diclofenac, is associated with increased cardiovascular risk, according to a very large study published online in Circulation.

Danish researchers used a national registry to study more than 83,000 patients who were admitted to the hospital for a first MI from 1997 to 2006. Some 42% of the patients received NSAIDs during the follow-up period, during which there were 35,257 recurrent MIs or death. The NSAID-associated risk started early in treatment and persisted over the treatment course:

  • First week: HR 1.45; CI 1.29-1.62
  • After 90 days: HR 1.55; CI 1.46-1.64

A significant increase in risk was observed with all the NSAIDs. The risk was slightly lower with naproxen, while diclofenac was associated with the highest risk (HR 3.26; CI 2.57-3.86 for death/MI in the first week).

The authors write: “Particularly worrying was the fact that the widely used nonselective NSAID diclofenac was associated with early and higher cardiovascular risk than the selective cyclooxygenase-2 inhibitor rofecoxib, which was withdrawn from the market in 2004 owing to its unfavorable cardiovascular risk profile. Our results indicate that there is no apparent safe therapeutic window for NSAIDs in patients with prior myocardial infarction and challenge the current recommendations of short-term use of NSAIDs as being safe. We believe this message is important, and should be distributed as widely as possible to clinicians taking care of patients with cardiovascular disease.”

Categories: General, Prevention
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4 Responses to “Short-Term NSAID Use Linked to Increased CV Risk”

  1. Darlene Louise Eyster, MD says:
    May 15, 2011 at 8:23 am

    I have warned my patients against NSAID use for many years now. My reasons have not been due to MI risk as much as concern that the type of pain being treated may in fact be untreated cardiac pain and because so many of my patients are diabetic with underlying renal disease.

  2. Robin Motz, M.D., Ph.D. says:
    May 16, 2011 at 9:49 pm

    Was any data included about concurrent aspirin use or non-use?

  3. William L Blanchet, MD says:
    May 16, 2011 at 11:34 pm

    Bring back Vioxx!!

    As long as all NSAIDS kill, at least bring back the one that worked.

  4. Rafael Perez-Mera Perez-Mera, MD says:
    May 17, 2011 at 6:25 am

    In the elderly with hypertension, diabetes and dyslipidemia, the use of NSAIA are not a good choice because of the renal effect. I had patients that created renal failure.