More evidence supporting cardiac danger of painkillers after MI

By Piriya Mahendra, medwireNews Reporter

Heart attack survivors who use nonsteroidal anti-inflammatory drugs (NSAIDSs) have an increased risk for long-term mortality or a second heart attack, research suggests.

Anne-Marie Olsen (Copenhagen University Hospital Gentofte, Hellerup, Denmark) and team explain that people who experience a heart attack typically face a higher risk for death or a second heart attack within the first year. But this heightened risk is thought to disappear within 5-10 years.

By contrast, their study, published in Circulation, shows that myocardial infarction (MI) survivors on NSAIDs have a persistently higher risk for adverse outcomes over at least 5 years, which means that "long-term caution with any use of NSAIDs is advised in all patients after heart attack," Olsen remarked in a press statement.

"It is important to get the message out to clinicians taking care of patients with cardiovascular disease that NSAIDs are harmful, even several years after a heart attack," she added.

Olsen and team found that of the 99,187 patients included in their study, 43,608 (44%) were prescribed NSAIDs after their index MI. During 5 years of follow-up, 36,747 deaths and 28,693 coronary deaths or nonfatal recurrent MIs occurred.

Compared with noncurrent treatment with NSAIDs, the use of NSAIDs following MI was significantly associated with a 59% increased risk for death after 1 year and a 63% increased risk for death after 5 years.

NSAID use after MI was also associated with a 30% increased risk for coronary death or nonfatal recurrent MI after 1 year and a 41% increased risk after 5 years.

"The results support previous findings suggesting that NSAIDs have no apparent safe treatment window among heart attack patients, and show that coronary risk related to using the drugs remains high, regardless of the time that has passed since the heart attack," explained Olsen.

The researchers say that as they did not test the effects of NSAIDs in a controlled clinical trial, their study does not definitively show that NSAIDs, as opposed to other factors, cause additional deaths or heart attacks.

Nonetheless, NSAID use should be limited and their over-the-counter availability should be re-evaluated, said Olsen.

"Allowing a drug to be sold without prescription must be perceived by the general public as a strong signal of safety, and may be contrary in this case," she commented.

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