Calls for conservative approach to drug use

Patients with cardiovascular disease (CVD) who take NSAIDs for even a short time are at increased risk of heart attack or death, research shows.

Warnings against their use by patients with CVD are included in product information for NSAIDs. But some are available OTC and many patients still take the drugs.

Copenhagen University Hospital researchers found that patients with prior MI had up to 3.3 times higher risk of recurrent MI or death within a week of starting NSAID treatment.

Ibuprofen, taken by nearly a quarter of patients in the study, raised risk by 1.5 times when taken for one to two weeks.

The raised risk was independent of the length of treatment and, for some NSAIDs, rose immediately after onset of treatment. The authors said: 'The results indicate that there is no apparent safe therapeutic window for NSAIDs in patients with prior MI and challenge the current recommendations of low-dose and short-term use of NSAIDs as being safe.'

To assess the safety of short-term use, researchers studied 83,675 patients who had first-time MI. Of these, 42.3 per cent later had at least one prescription for an NSAID. There were 35,257 recurrent MIs or deaths. Average risk rose to 1.5 times at onset of treatment and was the same regardless of treatment length of up to 90 days.

Diclofenac was associated with the highest risk, 3.3 times the background rate within the first seven days of treatment.

Lead author Anne-Marie Olsen said 'a very conservative approach to using NSAIDs in patients with prior heart attack is warranted'.

Stephen Robinson

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