Despite the fact that NSAIDs are not recommended among patients with established cardiovascular disease, many patients receive NSAID treatment for a short period of time. However, up until recently, data on the relationship between treatment duration and associated cardiovascular risk were sparse and have not been summarized.
A series of recent studies of patients with prior myocardial infarction (MI) demonstrated that short-term treatment with most NSAIDs is associated with an increased cardiovascular risk relative to no NSAID treatment. These studies furthermore demonstrated that NSAID use among patients with first-time MI was associated with persistently increased risk of all-cause mortality and of a composite of coronary death or nonfatal recurrent MI for at least 5 years thereafter.
The present review indicates that there is no apparent well-tolerated therapeutic window for associated cardiovascular risk and NSAID use in patients with prior MI. Further randomized studies are warranted to evaluate the cardiovascular safety of NSAIDs, but, at this point, the overall evidence suggests advising caution in using NSAIDs at all times after MI. Legislation bodies need to address this issue of public health proportions, as studies have shown that utilization rates of NSAID keep increasing.
aDepartment of Cardiology, Copenhagen University Hospital Gentofte, Hellerup
bFaculty of health and medical sciences, University of Copenhagen
cNational Institute of Public Health, University of Southern Denmark
dDepartment of Cardiology, the Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
eDuke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
Correspondence to Anne-Marie Schjerning Olsen, MD, Department of Cardiology – Post 635, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark. Tel: +45 60 16 93 40; fax: +45 70201283; e-mail: firstname.lastname@example.org