Those who have had a heart attack should never take a NSAID

Many people who have suffered a heart attack may be advised to take a non-steroidal anti-inflammatory drug (NSAID, such as ibuprofen, Advil, Motrin, Aleve, Celebrex and others*) for a variety of reasons, but a nation-wide cohort study just published in the journal Circulation reports that taking an NSAID can significantly increase their risk of death and they should never do so even for short periods. The authors set the stage for their study:

"Despite the fact that nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated among patients with established cardiovascular disease, many receive NSAID treatment for a short period of time. However, little is known about the association between NSAID treatment duration and risk of cardiovascular disease. We therefore studied the duration of NSAID treatment and cardiovascular risk in a nationwide cohort of patients with prior myocardial infarction (MI)."

They examined data for all Danish patients ≥30 years of age who had a first-time MI during 1997 to 2006 along with their subsequent NSAID use for risk of death and recurrent heart according to duration of NSAID treatment. What did the data show?

"Of the 83,677 patients included, 42.3% received NSAIDs during follow-up. There were 35 257 deaths/recurrent MIs. Overall, NSAID treatment was significantly associated with an increased risk of death/recurrent MI at the beginning of the treatment, and the risk persisted throughout the treatment course. Analyses of individual NSAIDs showed that the traditional NSAID diclofenac [Voltaren] was associated with the highest risk."

This study is an alarm that should be clearly heard by clinicians and any heart attack survivors who self-medicate with over-the-counter preparations. Practitioners should also not fail to consider a corollary implication: what about patients who, though they have not yet suffered an MI, have significant heart attack risk factors such as elevated Lp-PLA2? Fortunately there are alternatives to NSAID use for chronic inflammation. The authors conclude:

"Even short-term treatment with most NSAIDs was associated with increased risk of death and recurrent MI in patients with prior MI. Neither short- nor long-term treatment with NSAIDs is advised in this population, and any NSAID use should be limited from a cardiovascular safety point of view."

*including Nuprin, Naproxen, Relafen, Tolectin, etc.