Cardiovascular effects of anti-inflammatory drugs

This study investigated the consequences of ongoing treatment with non-steroidal anti-inflammatory drugs in patients who had a myocardial infarction (heart attack).

Non-steroidal anti-inflammatory drugs such as aspirin or ibuprofen (Advil) are medications usually given to reduce inflammation and pain. They work by inhibiting a protein in the body called cyclooxygenase. Two major classes of cyclooxygenase are found in the human body, COX-1 and COX-2. COX-1 is produced constantly in most tissues of the body, whereas COX-2 production is stimulated by inflammation (swelling and redness).  

While non-steroidal anti-inflammatory drugs give pain relief for inflammatory conditions, studies and analyses have raised concerns over the cardiovascular risk associated with these drugs. In particular, drugs that inhibit COX-2 such as diclofenac (Volatren), rofecoxib (Vioxx) and celecoxib (Celebrex) are associated with an increased risk of thromboembolic events (obstruction of a blood vessel by a blood clot that has become dislodged from another site in the circulation).

 This study aimed to evaluate the consequences of ongoing non-steroidal anti-inflammatory drug treatment in patients who have had a myocardial infarction.

This study evaluated 97,458 patients admitted to hospital with first-time myocardial infarction. 12.4% of all the patients were found to be on ongoing treatment with non-steroidal anti-inflammatory drugs at the time of admission. The most commonly used drugs were ibuprofen in 5.1% of subjects and diclofenac in 2.2 % of patients. The study analysed all-cause mortality (death by any cause) at 30 days and 1 year post-myocardial infarction.

The mortality rate within 30 days was 18.1%. Relative to no non-steroidal anti-inflammatory drug use, use of rofecoxib was associated with a 43% increased risk of death, celecoxib with a 23% increased risk of death and other non-steroidal anti-inflammatory drugs with a 15% increased risk of death. While these were deemed to be statistically significant, naproxen was associated with a non-significant increase in the risk of death of 14%, while diclofenac was not found to be associated with risk of death. Ongoing ibuprofen use was associated with a 9% decrease in the risk of death. This short-term benefit was not found to be associated with long-term prognosis (outcome of disease).

The mortality rate within 1 year was 27.7%. The 1-year risk of either death or recurrent myocardial infarction was 32.3%. Rofecoxib increased the risk of death at 1 year by 18%, celecoxib by 17% and diclofenac by 13%. Overall, the use of any non-steroidal anti-inflammatory drug increased the risk of death at 1 year by 7%.

The authors suggest that ongoing use of non-steroidal anti-inflammatory drugs should be included in the risk profile of a patient with myocardial infarction.