title: Risk of myocardial infarction and death associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) among healthy individuals: a nationwide cohort study.
abstract: Use of some nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with increased cardiovascular risk in several patient groups, but whether this excess risk exists in apparently healthy individuals has not been clarified. Using a historical cohort design, we estimated the risk of death and myocardial infarction associated with the use of NSAIDs. Participants in the study were selected from the Danish population and were defined as healthy according to a history of no hospital admissions and no concomitant selected pharmacotherapy. The source population consisted of 4,614,807 individuals, of whom 1,028,437 were included in the study after applying selection criteria. Compared to no NSAID use, hazard ratios (95% confidence limits) for death/myocardial infarction were 1.01 (0.96-1.07) for ibuprofen, 1.63 (1.52-1.76) for diclofenac, 0.97 (0.83-1.12) for naproxen, 2.13 (1.89-2.41) for rofecoxib, and 2.01 (1.78-2.27) for celecoxib. A dose-dependent increase in cardiovascular risk was seen for selective COX-2 inhibitors and diclofenac. Caution should be exercised in NSAID use in all individuals, and particularly high doses should be avoided if possible.
authors.affiliation: Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark. ELF@heart.dk
authors.forename: E L
authors.initials: EL
authors.lastname: Fosbøl
authors.forename: G H
authors.initials: GH
authors.lastname: Gislason
authors.forename: S
authors.initials: S
authors.lastname: Jacobsen
authors.forename: F
authors.initials: F
authors.lastname: Folke
authors.forename: M L
authors.initials: ML
authors.lastname: Hansen
authors.forename: T K
authors.initials: TK
authors.lastname: Schramm
authors.forename: R
authors.initials: R
authors.lastname: Sørensen
authors.forename: J N
authors.initials: JN
authors.lastname: Rasmussen
authors.forename: S S
authors.initials: SS
authors.lastname: Andersen
authors.forename: S Z
authors.initials: SZ
authors.lastname: Abildstrom
authors.forename: J
authors.initials: J
authors.lastname: Traerup
authors.forename: H E
authors.initials: HE
authors.lastname: Poulsen
authors.forename: S
authors.initials: S
authors.lastname: Rasmussen
authors.forename: L
authors.initials: L
authors.lastname: Køber
authors.forename: C
authors.initials: C
authors.lastname: Torp-Pedersen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002648:Child; D015331:Cohort Studies; D018592:Cross-Over Studies; D003643:Death; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal