Risk of acute myocardial infarction during use of individual NSAIDs: A nested case-control study from the SOS project

Gwen M.C. Masclee, Huub Straatman, Andrea Arfè, Jordi Castellsague, Edeltraut Garbe, Ron Herings, Bianca Kollhorst, Silvia Lucchi, Susana Perez-Gutthann, Silvana Romio, René Schade, Tania Schink, Martijn J. Schuemie, Lorenza Scotti, Cristina Varas-Lorenzo, Vera E. Valkhoff, Marco Villa, Miriam C.J.M. Sturkenboom

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Abstract

Background Use of selective COX-2 non-steroidal anti-inflammatory drugs (NSAIDs) (coxibs) has been associated with an increased risk of acute myocardial infarction (AMI). However, the risk of AMI has only been studied for very few NSAIDs that are frequently used. Objectives To estimate the risk of AMI for individual NSAIDs. Methods A nested case-control study was performed from a cohort of new NSAID users ≥ 18 years (1999-2011) matching cases to a maximum of 100 controls on database, sex, age, and calendar time. Data were retrieved from six healthcare databases. Adjusted odds ratios (ORs) of current use of individual NSAIDs compared to past use were estimated per database. Pooling was done by two-stage pooling using a random effects model (ORmeta) and by one-stage pooling (ORpool). Results Among 8.5 million new NSAID users, 79,553 AMI cases were identified. The risk was elevated for current use of ketorolac (ORmeta 2.06;95%CI 1.83-2.32, ORpool 1.80; 1.49- 2.18) followed, in descending order of point estimate, by indometacin, etoricoxib, rofecoxib, diclofenac, fixed combination of diclofenac with misoprostol, piroxicam, ibuprofen, naproxen, celecoxib, meloxicam, nimesulide and ketoprofen (ORmeta 1.12; 1.03-1.22, ORpool 1.00;0.86-1.16). Higher doses showed higher risk estimates than lower doses. Conclusions The relative risk estimates of AMI differed slightly between 28 individual NSAIDs. The relative risk was highest for ketorolac and was correlated with COX-2 potency, but not restricted to coxibs.

Original languageEnglish
Article numbere0204746
JournalPLOS ONE
Volume13
Issue number11
DOIs
Publication statusPublished - Nov 2018

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