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Most NSAIDs raise risk of
death after heart attack
13/11/05 - 16/11/05, Dallas, Texas
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Scientific Sessions, the largest cardiovascular meeting
in the world, is being held in Dallas, Texas Nov. 13–16.
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DALLAS, Nov. 13 — Taking either COX-2 inhibitors or other
non-steroidal anti-inflammatory drugs (NSAIDs) after a heart
attack, especially in high doses, increases the risk of death,
researchers reported at the American Heart Association’s
Scientific Sessions 2005.
Researchers note that this study did not include aspirin.
“There is no doubt about the beneficial effects of aspirin among
patients after heart attack, which is a cheap and effective
treatment — and the scientific evidence is undeniable,” said
Gunnar H. Gislason, M.D., lead author and research fellow at
Bispebjerg University Hospital in Copenhagen, Denmark.
In recent years, evidence has shown that patients treated
with selective cyclo-oxygenase-2 (COX-2) inhibitors are at
increased risk of heart attack and death. COX-2 inhibitors are
used primarily to treat pain and arthritis in patients at risk
of gastrointestinal bleeding. This is the first study to look at
patients who take the drugs after suffering their first heart
attack.
“These results are a cause for concern but not panic. If you
can avoid them, it makes sense to switch to another type of
medication if you have cardiovascular disease,” said Gislason.
The researchers examined records in the Danish National
Patients Registry of 58,432 men and women discharged from the
hospital from 1995–2002 after a first acute heart attack.
Researchers tracked prescriptions of selective COX-2 inhibitors
and other NSAIDs after discharge, their dosages, and for how
long they were prescribed.
At some point after discharge, patients were treated as
follows:
- 3,022 (5.2 percent) were treated at least once with
rofecoxib (Vioxx)
- 2,489 (4.3 percent) received celecoxib (Celebrex)
- 6,172 (10.6 percent) received diclofenac (Cataflam and
Voltaren)
- 7,449 (12.7 percent) received other NSAIDS
- 10,230 (17.5 percent) received ibuprofen (such as Advil
and Motrin)
Patients receiving any or none of the studied NSAIDs also may
have been taking aspirin to lower the risk of a recurrent heart
attack.
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The researchers analyzed the risk of a second heart attack or
death from any cause during the time patients were taking one of
the medications, compared with patients who were not. Patients
were at a strikingly higher risk of death while taking high
doses of COX-2 inhibitors or other NSAIDs, researchers said.
The hazard ratio, which indicates the risk of dying while
taking one of the drugs, compared with a risk of 1.0 for similar
patients not taking NSAIDs (patients matched to control for age,
gender and other medical conditions), was:
- 4.24 for more than 200 mg/day of celecoxib
- 5.03 for more than 25 mg/day of rofecoxib
- 3.76 for more than 100 mg/day of diclofenac
- 1.22 for other NSAIDs (other non-specified NSAIDs were
not divided into high or low dosages because it was a very
heterogeneous group)
- 1.96 for more than 1200 mg/day of ibuprofen
Lower doses of celecoxib (hazard ratio 1.70) and rofecoxib
(2.23) were also associated with a significantly higher risk of
death, which was not found with lower doses of ibuprofen (hazard
ratio 0.66) or diclofenac (0.74).
“The most important thing to recognize is that higher doses
give a higher risk of death,” Gislason said.
However, researchers did not find an increased risk of a
second heart attack with any of the drugs or dosages. “This
really surprised us because we had expected that the risk of
recurrent heart attack would be high in this population,”
Gislason said.
The research team is analyzing death certificates to see what
(if any) causes of death were more common in patients taking the
drugs. “We’re looking at both cardiovascular and
non-cardiovascular causes of death,” Gislason stated.
Gislason recommends that patients with cardiovascular disease
who are taking COX-2 inhibitors or other NSAIDs should talk to
their doctors.
The study was funded by a research fellowship from the Danish
Heart Foundation and an independent research grant from the
Danish Pharmaceutical Association.
Co-authors are: Søren Jacobsen, M.D., Ph.D.; Pernille Buch,
M.D.; Jeppe N. Rasmussen, M.D.; Jens Friberg, M.D., Ph.D.; Steen
Z. Abildstrom, M.D., Ph.D.; and Christian Torp-Pedersen, M.D.,
Ph.D.
Sources
American Heart Association - Scientific Sessions - 2005
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