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Meta-Analysis
. 2006;8(5):R153.
doi: 10.1186/ar2047.

Risk of acute myocardial infarction with nonselective non-steroidal anti-inflammatory drugs: a meta-analysis

Gurkirpal Singh  1 , Olivia Wu, Peter Langhorne, Rajan Madhok
Affiliations
Meta-Analysis

Risk of acute myocardial infarction with nonselective non-steroidal anti-inflammatory drugs: a meta-analysis

Gurkirpal Singh et al. Arthritis Res Ther. 2006.

Abstract

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.

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Figures

Figure 1
Figure 1
Selection of studies included in the meta-analysis.
Figure 2
Figure 2
The relative AMI risk associated with use of nonselective NSAIDs versus remote use or non-use. There may be small discrepancies between the individual study values presented here and those presented in the original studies. This is due to the function of the software used for the calculation. One study did not present data on polled NSAIDs and is excluded from this figure. AMI, acute myocardial infarction; NSAID, nonsteroidal anti-inflammatory drug.
See this image and copyright information in PMC

Comment in

  • NSAIDs and the risk of acute myocardial infarction.
    García Rodríguez LA, González-Pérez A. García Rodríguez LA, et al. Nat Clin Pract Rheumatol. 2007 Apr;3(4):202-3. doi: 10.1038/ncprheum0459. Epub 2007 Mar 6. Nat Clin Pract Rheumatol. 2007. PMID: 17342079 No abstract available.

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