Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for pain and inflammation, but their use in patients newly diagnosed with myocardial infarction or heart failure is now ringing alarm bells.
Using health registries from 1996 to 2018, Danish investigators carried out a comprehensive cohort study. It encompassed 273,682 patients diagnosed with their first myocardial infarction or heart failure. Of these, 97,966 had been prescribed NSAIDs. They were categorized based on their usage: continuing users (17%) or those initiating (83%).
Denmark’s stringent regulations around NSAIDs mean that the data from the Danish National Prescription Registry offers a reasonably accurate depiction of NSAID consumption in the nation.
Continuing NSAID users tended to be older and predominantly female, with a higher burden of comorbidities. The most popular NSAIDs were ibuprofen (50%), followed by diclofenac (20%), etodolac (8.5%), and naproxen (4.3%).
The findings revealed a heightened risk, with a hazard ratio of 1.25 for the combined outcome of all-cause death and new myocardial infarction or heart failure admission. This risk was driven by NSAID initiators. Notably, ibuprofen and naproxen showed no associated risk for continuing users, but diclofenac did indicate a slightly increased outcome rate.
Interpreting the Results
While this study offers crucial insights, it is essential to note that filled prescriptions don’t necessarily equate to drug adherence. However, the consistency of the results across various analyses strengthens the study’s significance.
The study underscores a vital concern: the alarming prevalence of contraindicated NSAID use in patients freshly diagnosed with myocardial infarction or heart failure. It calls for a review and intervention by healthcare authorities and pertinent medical organizations. Patients with a new myocardial infarction or heart failure diagnosis represent a vulnerable group. In such cases, alternative pain management strategies should be the priority over NSAIDs.
