Risk of acute myocardial infarction with nonselective non-steroidal anti-inflammatory drugs: a meta-analysis
1 Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 100 Hamilton Avenue, Suite 225 #42, Palo Alto, CA, 94301, USA
2 Institute of Clinical Outcomes Research and Education, 100 Hamilton Avenue, Suite 225 #42, Palo Alto, CA, 94301, USA
3 Division of Developmental Medicine, University of Glasgow, Glasgow Royal Infirmary, Castle Street, Glasgow, G4 0SF, UK
4 Division of Cardiovascular Medicine and Medical Sciences, University of Glasgow, Glasgow Royal Infirmary, Castle Street, Glasgow, G4 0SF, UK
5 Centre for Rheumatic Diseases, Glasgow Royal Infirmary, Castle Street, Glasgow, G4 0SF, UK
Arthritis Research & Therapy 2006, 8:R153 doi:10.1186/ar2047Published: 22 September 2006
The use of cyclo-oxygenase 2 selective nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with increased risk of acute myocardial infarction (AMI). The association between the risks of AMI with nonselective NSAIDs is less clear. We reviewed the published evidence and assessed the risk of AMI with nonselective NSAIDs. We performed a meta-analysis of all studies containing data from population databases that compared the risk of AMI in NSAID users with that in non-users or remote NSAID users. The primary outcome was objectively confirmed AMI. Fourteen studies met predefined criteria for inclusion in the meta-analysis. Nonselective NSAIDs as a class was associated with increased AMI risk (relative AMI risk 1.19, 95% confidence interval [CI] 1.08 to 1.31). Similar findings were found with diclofenac (relative AMI risk 1.38, 95% CI 1.22–1.57) and ibuprofen (relative AMI risk 1.11, 95% CI 1.06 to 1.17). However, this effect was not observed with naproxen (relative AMI risk 0.99, 95% CI 0.88–1.11). In conclusion, based on current evidence, there is a general direction of effect, which suggests that at least some nonselective NSAIDs increase AMI risk. Analysis based on the limited data available for individual NSAIDs, including diclofenac and ibuprofen, supported this finding; however, this was not the case for naproxen. Nonselective NSAIDs are frequently prescribed, and so further investigation into the risk of AMI is warranted because the potential for harm can be substantial.