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NSAIDs Ups Risk of Dying After a Myocardial Infarction: Presented at AHA

By Charlene Laino

DALLAS, TX -- November 22, 2005 -- Taking nonsteroidal anti-inflammatory drugs (NSAIDs), especially at high doses, may increase death rates among patients with a history of myocardial infarction (MI).

Research has already shown that NSAIDs -- including ibuprofen and selective cyclo-oxygenase-2 (COX-2) inhibitors -- increase the risk of myocardial infarction in patients with arthritis, said investigator Gunnar H. Gislason, MD, Research Fellow, Bispebjerg University Hospital, Copenhagen, Denmark.

Dr. Gislason presented the findings, from the first study to look at patients who take the NSAIDs after having an acute MI, at the American Heart Association's Scientific Sessions 2005 (AHA) here on November 13^th.

His findings suggest that NSAIDS may carry even greater risks for patients with existing heart disease than in other patients, he said.

Dr. Gislason and colleagues analyzed data on 58,432 patients in the Danish National Patients' Registry who were discharged from hospitals between 1995 and 2002 after a first MI. Using a national prescription database, they identified all prescriptions for selective COX-2 inhibitors and other NSAIDs after hospital discharge.

Their results show that 5.2% of patients had prescriptions for rofecoxib, 4.3% celecoxib, 17.5% ibuprofen, 10.6% diclofenac, and 12.7% had taken other NSAIDs.

All the NSAIDs were associated with an increased risk of all-cause mortality, and higher doses increased rates further, the researchers found. "But to our surprise, neither the selective COX-2 inhibitors nor other NSAIDS increased the risk of recurrent MI," Dr. Gislason reported.

Compared with subjects not taking any anti-inflammatory drugs, subjects who took more than 200 mg/day of celecoxib were 4.24 times more likely to die and subjects who took more than 25 mg/day of rofecoxib were 5.03 times more likely to die, the results show.

Also, subjects who took more than 1200 mg/ of ibuprofen were 96% more likely to die as those who did not take NSAIDs.

High doses of diclofenac (more than 100 mg/day) were associated with a 3.76-fold increased risk of death.

All the values reached significance at the P < .001 level, Dr. Gislason said.

Lower doses of celecoxib raised the risk of dying by 70%, while lower does of rofecoxib raised the risk by 2.23-fold (P < .001). But lower doses of ibuprofen appeared to be protective.

The researchers are now looking at participants' hospital records and causes of death to determine why high doses are so deadly.

"We found that hospital readmissions for heart failure are two to three times higher in people on COX-2 inhibitors and about 50% higher in people taking ibuprofen after a heart attack, so that may play a role," Dr. Gislason said. "But it could be that a lot of these people are having second heart attacks and dying before they ever reach the hospital."


[Presentation title: Increased Mortality Related to Treatment with Selective Cyclo-Oxygenase-2 Inhibitors and Non-Steroidal Anti-Inflammatory Drugs after Acute Myocardial Infarction. Abstract 1838]

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