It is well known that oral nonsteroidal antiinflammatory drugs (NSAIDs) can increase the risk of acute myocardial infarction (AMI). Researchers conducted an individual patient data meta-analysis to determine the time course for risk of AMI and the effects of dose and duration of use when using the main, traditional NSAIDs (diclofenac, ibuprofen, and naproxen) and two selective cyclooxygenase-2 inhibitors, celecoxib and rofecoxib.
The researchers searched computerized databases for studies conducted in the general or elderly population that compared the risk of AMI in NSAID users and nonusers. They only included studies conducted before rofecoxib was withdrawn from the market (September 30, 2004). The pooled data comprised 446,763 individuals—61,460 cases and 385,303 controls.
The findings indicate that the current use of NSAIDs is associated with an increased risk of AMI. The odds ratio of an AMI with the use of an NSAID for one to seven days is 1.24 for celecoxib, 1.48 for ibuprofen, 1.50 for diclofenac, 1.53 for naproxen, and 1.58 for rofecoxib. The risk appears to increase immediately with exposure, to be greater with higher doses, and to decrease over time since the last use of an NSAID. The risk doesn't appear to be greater when taking the medications for longer than one month compared with short-term use (with the possible exception of diclofenac). Taking high doses of ibuprofen, naproxen, or rofecoxib for eight to 30 days is particularly harmful. The risk associated with the use of celecoxib doesn't seem to be higher than that associated with traditional NSAID use. With rofecoxib, by contrast, the risk is higher than for other NSAIDs.
Bally M, et al BMJ 2017 357 j1909