title: Long-term cardiovascular risk of nonsteroidal anti-inflammatory drug use according to time passed after first-time myocardial infarction: a nationwide cohort study.
abstract: BACKGROUND
  The cardiovascular risk after the first myocardial infarction (MI) declines rapidly during the first year. We analyzed whether the cardiovascular risk associated with using nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with the time elapsed following first-time MI.
  
  
  RESULTS
  We identified patients aged 30 years or older admitted with first-time MI in 1997 to 2009 and subsequent NSAID use by individual-level linkage of nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark. We calculated the incidence rates of death and a composite end point of coronary death or nonfatal recurrent MIs associated with NSAID use in 1-year time intervals up to 5 years after inclusion and analyzed risk by using multivariable adjusted time-dependent Cox proportional hazards models. Of the 99 187 patients included, 43 608 (44%) were prescribed NSAIDs after the index MI. There were 36 747 deaths and 28 693 coronary deaths or nonfatal recurrent MIs during the 5 years of follow-up. Relative to noncurrent treatment with NSAIDs, the use of any NSAID in the years following MI was persistently associated with an increased risk of death (hazard ratio 1.59 [95% confidence interval, 1.49-1.69]) after 1 year and hazard ratio 1.63 [95% confidence interval, 1.52-1.74] after 5 years) and coronary death or nonfatal recurrent MI (hazard ratio, 1.30 [95% confidence interval,l 1.22-1.39] and hazard ratio, 1.41 [95% confidence interval, 1.28-1.55]).
  
  
  CONCLUSIONS
  The use of NSAIDs is associated with persistently increased coronary risk regardless of time elapsed after first-time MI. We advise long-term caution in the use of NSAIDs for patients after MI.
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark. amschjerning@gmail.com
authors.forename: Anne-Marie Schjerning
authors.initials: AM
authors.lastname: Olsen
authors.forename: Emil L
authors.initials: EL
authors.lastname: Fosbøl
authors.forename: Jesper
authors.initials: J
authors.lastname: Lindhardsen
authors.forename: Fredrik
authors.initials: F
authors.lastname: Folke
authors.forename: Mette
authors.initials: M
authors.lastname: Charlot
authors.forename: Christian
authors.initials: C
authors.lastname: Selmer
authors.forename: Jonas
authors.initials: J
authors.lastname: Bjerring Olesen
authors.forename: Morten
authors.initials: M
authors.lastname: Lamberts
authors.forename: Martin H
authors.initials: MH
authors.lastname: Ruwald
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.forename: Peter R
authors.initials: PR
authors.lastname: Hansen
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: Gunnar H
authors.initials: GH
authors.lastname: Gislason
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D015897:Comorbidity; D000075202:Contraindications; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D010604:Pharmacy / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data*; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal