NSAIDs increase the risk for heart attack

Bally M, Dendukuri N, Rich B, et al. Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ. 2017 May 9;357:j1909.

Review question

Does using nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk for heart attack (acute myocardial infarction)?

Background

NSAIDs are often used to treat pain, fever, and inflammation due to muscle pain and arthritis. Commonly used NSAIDs include ibuprofen, celecoxib, and naproxen. These drugs are available over the counter; however, higher doses usually require a doctor’s prescription.

NSAIDs may increase a person’s risk for a heart attack.

How the review was done

The researchers did a systematic review, searching for studies that were published up to November 2013.

They found 4 studies including 446,763 people (average age 73 years). They combined the data from all patients and compared patients who used oral NSAIDs (pills) in the past year with people who had not used NSAIDs in the past year.

NSAIDs included were celecoxib, diclofenac, ibuprofen, naproxen, and rofecoxib (rofecoxib is no longer available).

What the researchers found

Compared with not using NSAIDs in the past year, risk for heart attack was increased with:

• any dose of diclofenac or naproxen for 1 to 7 days;
• high-dose naproxen (more than 750 mg/day) for 8 to 30 days—risk does not appear to be increased beyond 30 days; and
• use of celecoxib, diclofenac, or ibuprofen for more than 30 days.

Conclusion

Using oral NSAIDs increases the risk for a heart attack, but the risk varies by the specific NSAID, dose, and length of use. (Caution - see your doctor before starting or stopping any prescribed medications.)