Naproxen use in patients with recent serious coronary heart disease was associated with a lower risk of serious coronary events compared to nonusers (IRR 0.88; 95% CI 0.66-1.17).
Cohort (n=48,566)
Yes
Does the use of individual NSAIDs increase the risk of serious coronary heart disease or cardiovascular disease/death in patients recently hospitalized for serious coronary heart disease compared to nonusers or naproxen?
In patients with recent serious coronary heart disease, naproxen appears to have a better cardiovascular safety profile compared to other NSAIDs like diclofenac, ibuprofen, celecoxib, and rofecoxib.
Effect estimate: IRR 0.88 (95% CI 0.66 to 1.17)
BACKGROUND: The cardiovascular safety of individual nonsteroidal antiinflammatory drugs (NSAIDs) is highly controversial, particularly in persons with serious coronary heart disease. METHODS AND RESULTS: We conducted a multisite retrospective cohort study of commonly used individual NSAIDs in Tennessee Medicaid, Saskatchewan Health, and United Kingdom General Practice Research databases. The cohort included 48566 patients recently hospitalized for myocardial infarction, revascularization, or unstable angina pectoris with more than 111000 person-years of follow-up. Naproxen users had the lowest adjusted rates of serious coronary heart disease (myocardial infarction, coronary heart disease death) and serious cardiovascular disease (myocardial infarction, stroke)/death from any cause, with respective incidence rate ratios (relative to NSAID nonusers) of 0.88 (95% CI, 0.66 to 1.17) and 0.91 (0.78 to 1.06). Risk did not increase with doses >or=1000 mg. Relative to NSAID nonusers, serious coronary heart disease risk increased with short term (or=1000 mg, serious coronary heart disease incidence rate ratios were increased for rofecoxib >25 mg (2.29 1.24 to 4.22, P=0.008) and celecoxib >200 mg (1.61 1.01 to 2.57, P=0.046). CONCLUSIONS: In patients recently hospitalized for serious coronary heart disease, naproxen had better cardiovascular safety than did diclofenac, ibuprofen, and higher doses of celecoxib and rofecoxib.
Ray et al. (Fri,) conducted a cohort in serious coronary heart disease (n=48,566). NSAIDs (naproxen, ibuprofen, diclofenac, celecoxib, rofecoxib) vs. NSAID nonusers was evaluated on serious coronary heart disease (myocardial infarction, coronary heart disease death) (IRR 0.88, 95% CI 0.66 to 1.17). Naproxen use in patients with recent serious coronary heart disease was associated with a lower risk of serious coronary events compared to nonusers (IRR 0.88; 95% CI 0.66-1.17).