Nonsteroidal anti-inflammatory drugs (NSAIDs) use is associated with a significantly increased risk for myocardial infarction (MI). This includes naproxen, considered by some as one of the safest drugs in this class. This is according to a new patient level meta-analysis from the University of Montreal, studying celecopxib, diclofenac, ibuoprofen, naproxen and rofecoxib.

The increase in MI risk for current NSAID use was 20% to 50% compared with those not using these drugs. This was found for all traditional NSAIDS, including naproxen. The risk for acute MI for celecoxib was not greater than that for traditional NSAIDs and was lower than that for rofecoxib.

Acute MI risk associated with NSAID use

- Celecoxib: odds ratio 1.24 (0.91-1.82)

- Ibuprofen: odds ratio 1.48 (1.00-2.26)

- Diclofenac: odds ratio 1.50 (1.06-2.04)

- Naproxen: odds ratio 1.53 (1.07-2.33)

- Rofecoxib: odds ratio 1.58 (1.07-2.17)

Other important points include

- The increased MI risk occurred as early as the first week of NSAIDs use.

- Use of higher doses was associated with increased MI risk.

- Longer duration of treatment generally did not seem to be associated with greater probability of increased MI risk, i.e. for duration of treatment, risk does not go away but does not increase further

The exact mechanism is unknown, but may be related to the selective COX-2 enzyme inhibition, which may increase blood pressure.

The increased MI risk occurred as early as the first week of NSAIDs use and the risk was greater with higher doses.

Reference:

Bally et al. Risk of acute myocardial infarction with NSAIDs in real world use: Bayesian meta-analysis of individual patient data. BMJ 2017;357;j1909.

Author: Dr Andrew To