Time-perspective in cardiovascular risk of NSAID use after first-time myocardial infarction.
OBJECTIVE
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.


RESULTS
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.


CONCLUSIONS
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.
Anne-Marie Schjerning
AM
Olsen
Gunnar H
GH
Gislason
Emil L
EL
Fosbøl
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000401:mortality*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D009203:Myocardial Infarction; D012307:Risk Factors; D013997:Time Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal