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Risk of acute myocardial infarction during use of individual NSAIDs: A nested case-control study from the SOS project

Author

Listed:
  • Gwen M C Masclee
  • Huub Straatman
  • Andrea Arfè
  • Jordi Castellsague
  • Edeltraut Garbe
  • Ron Herings
  • Bianca Kollhorst
  • Silvia Lucchi
  • Susana Perez-Gutthann
  • Silvana Romio
  • René Schade
  • Tania Schink
  • Martijn J Schuemie
  • Lorenza Scotti
  • Cristina Varas-Lorenzo
  • Vera E Valkhoff
  • Marco Villa
  • Miriam C J M Sturkenboom

Abstract

Background: Use of selective COX-2 non-steroidal anti-inflammatory drugs (NSAIDs) (coxibs) has been associated with an increased risk of acute myocardial infarction (AMI). However, the risk of AMI has only been studied for very few NSAIDs that are frequently used. Objectives: To estimate the risk of AMI for individual NSAIDs. Methods: A nested case-control study was performed from a cohort of new NSAID users ≥18 years (1999–2011) matching cases to a maximum of 100 controls on database, sex, age, and calendar time. Data were retrieved from six healthcare databases. Adjusted odds ratios (ORs) of current use of individual NSAIDs compared to past use were estimated per database. Pooling was done by two-stage pooling using a random effects model (ORmeta) and by one-stage pooling (ORpool). Results: Among 8.5 million new NSAID users, 79,553 AMI cases were identified. The risk was elevated for current use of ketorolac (ORmeta 2.06;95%CI 1.83–2.32, ORpool 1.80; 1.49–2.18) followed, in descending order of point estimate, by indometacin, etoricoxib, rofecoxib, diclofenac, fixed combination of diclofenac with misoprostol, piroxicam, ibuprofen, naproxen, celecoxib, meloxicam, nimesulide and ketoprofen (ORmeta 1.12; 1.03–1.22, ORpool 1.00;0.86–1.16). Higher doses showed higher risk estimates than lower doses. Conclusions: The relative risk estimates of AMI differed slightly between 28 individual NSAIDs. The relative risk was highest for ketorolac and was correlated with COX-2 potency, but not restricted to coxibs.

Suggested Citation

  • Gwen M C Masclee & Huub Straatman & Andrea Arfè & Jordi Castellsague & Edeltraut Garbe & Ron Herings & Bianca Kollhorst & Silvia Lucchi & Susana Perez-Gutthann & Silvana Romio & René Schade & Tania Sc, 2018. "Risk of acute myocardial infarction during use of individual NSAIDs: A nested case-control study from the SOS project," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-18, November.
    • Handle: RePEc:plo:pone00:0204746
    DOI: 10.1371/journal.pone.0204746
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    References listed on IDEAS

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    1. Patricia McGettigan & David Henry, 2011. "Cardiovascular Risk with Non-Steroidal Anti-Inflammatory Drugs: Systematic Review of Population-Based Controlled Observational Studies," PLOS Medicine, Public Library of Science, vol. 8(9), pages 1-18, September.
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    Cited by:

    1. Nicholas Moore, 2020. "Coronary Risks Associated with Diclofenac and Other NSAIDs: An Update," Drug Safety, Springer, vol. 43(4), pages 301-318, April.

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