Conference Coverage

NSAID Use Post MI Boosted A Fib and Stroke



CHICAGO – Patients who received treatment with a nonsteroidal anti-inflammatory drug following a first-time myocardial infarction had a significantly increased rate of subsequent atrial fibrillation or stroke, based on data collected since 1997 from more than 88,000 Danish residents.

Compared with patients who did not receive an NSAID, those given at least one prescription of a NSAID following hospitalization for a first-time myocardial infarction (MI) had statistically significant increased rates of subsequent atrial fibrillation, 23%, and of a subsequent stroke, 25%, in an analysis that adjusted for possible confounders, Dr. Anne-Marie Schjerning Olsen and her associates reported in a poster at the meeting.

The findings add to existing evidence that NSAID treatment poses a cardiovascular risk to certain patients. Further, the results highlight the need to assess cardiovascular risk and balance that risk from NSAID treatment against its possible benefit before prescribing these drugs, they said.

Last year, Dr. Olsen and her associates reported results from another analysis using the same database showing that NSAID use by patients following a MI boosted their risk for death or a second MI.

The new study reviewed nationwide hospitalization and pharmacy records for 88,458 Danish residents who were at least 30 years old, were hospitalized for a first-time MI during 1997-2009 and had no history of prior atrial fibrillation. Their mean age was 68 years, and 64% were men. During follow-up, 46% of the patients filled at least one prescription for an NSAID. In addition, during the study period, 9,578 of the post-MI patients were hospitalized for atrial fibrillation, and 7,687 were hospitalized for a stroke.

Among the NSAID users, the incidence of atrial fibrillation in the post-MI patients was 26.9 cases/1,000 person-years, and the stroke incidence was 21.2 cases/1,000 person-years, reported Dr. Olsen, a cardiology researcher at Gentofte Hospital in Copenhagen, and her associates.

In an analysis that adjusted for age, gender, calendar year, concomitant drug use, and comorbidities, use of any type of NSAID boosted the atrial fibrillation risk by 23% and the stroke risk by 25%, compared with the risk in patients who did not take an NSAID.

The greatest adverse effect was linked with rofecoxib (Vioxx) treatment, which was associated with a 35% increased risk for atrial fibrillation and a 2.5-fold increased risk for stroke, both statistically significant differences, compared with non–NSAID users.

Other individual NSAIDs in the analysis included celecoxib (Celebrex), which was linked with a statistically significant, roughly 80% increased rate of stroke compared with non–NSAID users. Celecoxib did not have a significant impact on atrial fibrillation rate. Ibuprofen and diclofenac each boosted the rate of atrial fibrillation and of stroke by about the same amount as did all of the NSAIDs together. Naproxen did not have a statistically significant effect on either end point.

Dr. Olsen said that she had no disclosures.

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