Current use of rofecoxib was associated with an increased risk of hospitalization for myocardial infarction compared with nonuse of nonaspirin NSAIDs (adjusted RR 1.80; 95% CI 1.47-2.21).
Case-Control (n=113,077)
Yes
Does the use of nonaspirin NSAIDs increase the risk of hospitalization for myocardial infarction in the general population?
Current and new use of all classes of nonaspirin NSAIDs, including COX-2 inhibitors and conventional NSAIDs, is associated with an increased risk of hospitalization for myocardial infarction.
Relative Risk: 1.8 (95% CI 1.47–2.21)
BACKGROUND: It remains uncertain if the excess cardiovascular risk of rofecoxib and celecoxib reported in clinical trials is present in routine practice and whether the use of other nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) also carries an increased cardiovascular risk. We performed a population-based case-control study to examine the risk of myocardial infarction (MI) among users of various categories of nonaspirin NSAIDs. METHODS: Using data from hospital discharge registries in the counties of North Jutland, Viborg, and Aarhus, Denmark, and the Danish Civil Registration System, we identified 10,280 cases of first-time hospitalization for MI and 102,797 sex- and age-matched non-MI population controls. All prescriptions for nonaspirin NSAIDs filled before the date of admission for MI were identified using population-based prescription databases. Relative risk estimates for MI were adjusted for a history of cardiovascular disease, hypertension, diabetes mellitus, chronic bronchitis or emphysema, alcoholism, liver cirrhosis, upper gastrointestinal bleeding, rheumatoid arthritis, systemic lupus erythematosus and the use of high-dose aspirin, platelet inhibitors, insulin or oral hypoglycemic drugs, antihypertensive drugs, lipid-lowering drugs, oral anticoagulants, nitrates, penicillamine, gold, oral glucocorticoids, and hormone therapy before the date of admission for MI. RESULTS: Current users of rofecoxib had an elevated risk estimate for hospitalization for MI compared with nonusers of any category of nonaspirin NSAIDs (adjusted relative risk ARR, 1.80; 95% confidence interval CI, 1.47-2.21). Increased risk estimates were also found among current users of celecoxib (ARR, 1.25; 95% CI, 0.97-1.62), other cyclooxygenase-2 selective inhibitors (ARR, 1.45; 95% CI, 1.09-1.93), naproxen (ARR, 1.50; 95% CI, 0.99-2.29), and other conventional nonaspirin NSAIDs (ARR, 1.68; 95% CI, 1.52-1.85). The highest ARRs were found among new users of all examined drug categories. CONCLUSIONS: Current and new users of all classes of nonaspirin NSAIDs had elevated relative risk estimates for MI. Although the increased risk estimates may partly reflect unmeasured bias, they indicate the need for further examination of the cardiovascular safety of all nonaspirin NSAIDs.
Søren Paaske Johnsen (Mon,) conducted a case-control in Myocardial infarction (n=113,077). Rofecoxib vs. Nonusers of any category of nonaspirin NSAIDs was evaluated on Hospitalization for myocardial infarction (RR 1.80, 95% CI 1.47-2.21). Current use of rofecoxib was associated with an increased risk of hospitalization for myocardial infarction compared with nonuse of nonaspirin NSAIDs (adjusted RR 1.80; 95% CI 1.47-2.21).