Journal Article

Risk of acute myocardial infarction during use of individual NSAIDs: A nested case-control study from the SOS project

Masclee, Gwen M. C., Kollhorst, Bianca, Schink, Tania, Varas-Lorenzo, Cristina, Arfè, Andrea, Herings, Ron, Lucchi, Silvia, Romio, Silvana, Valkhoff, Vera E., Perez-Gutthann, Susana, Straatman, Huub, Schuemie, Martijn J., Sturkenboom, Miriam C. J. M., Villa, Marco, Scotti, Lorenza, Castellsague, Jordi, Garbe, Edeltraut, Schade, René

2018

Overview

Use of selective COX-2 non-steroidal anti-inflammatory drugs (NSAIDs) (coxibs) has been associated with an increased risk of acute myocardial infarction (AMI). However, the risk of AMI has only been studied for very few NSAIDs that are frequently used. To estimate the risk of AMI for individual NSAIDs. A nested case-control study was performed from a cohort of new NSAID users ≥18 years (1999-2011) matching cases to a maximum of 100 controls on database, sex, age, and calendar time. Data were retrieved from six healthcare databases. Adjusted odds ratios (ORs) of current use of individual NSAIDs compared to past use were estimated per database. Pooling was done by two-stage pooling using a random effects model (ORmeta) and by one-stage pooling (ORpool). Among 8.5 million new NSAID users, 79,553 AMI cases were identified. The risk was elevated for current use of ketorolac (ORmeta 2.06;95%CI 1.83-2.32, ORpool 1.80; 1.49-2.18) followed, in descending order of point estimate, by indometacin, etoricoxib, rofecoxib, diclofenac, fixed combination of diclofenac with misoprostol, piroxicam, ibuprofen, naproxen, celecoxib, meloxicam, nimesulide and ketoprofen (ORmeta 1.12; 1.03-1.22, ORpool 1.00;0.86-1.16). Higher doses showed higher risk estimates than lower doses. The relative risk estimates of AMI differed slightly between 28 individual NSAIDs. The relative risk was highest for ketorolac and was correlated with COX-2 potency, but not restricted to coxibs.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Aged / Aged, 80 and over / Analysis / Anti-inflammatory agents / Anti-Inflammatory Agents, Non-Steroidal - adverse effects / Arthritis / Case studies / Case-Control Studies / Celecoxib / Clinical trials / Complications and side effects / Control methods / Cyclooxygenase-2 / Diclofenac / Diclofenac - adverse effects / Disease / Disease prevention / Dosage and administration / Epidemiology / Etoricoxib - adverse effects / Female / Gastroenterology / Health care / Health informatics / Health risk assessment / Health risks / Health services / Heart attack / Heart attacks / Hepatology / Humans / Ibuprofen / Indomethacin - adverse effects / Inflammation / Ketoprofen / Ketorolac - adverse effects / Lactones - adverse effects / Male / Medical records / Medicine and health sciences / Meloxicam / Meta-analysis / Methods / Middle Aged / Misoprostol / Myocardial infarction / Myocardial Infarction - chemically induced / Naproxen / Nimesulide / Nonsteroidal anti-inflammatory drugs / Odds Ratio / Physical Sciences / Piroxicam / Population / Public health / Research and Analysis Methods / Risk / Risk Factors / Rofecoxib / Studies / Sulfones - adverse effects / Systematic review / Thrombosis