Key result
In patients with prior MI, NSAID use was associated with an increased risk of MACE compared to non-use (HR 1.21; 95% CI 1.11-1.32), which was not influenced by baseline LDL-C levels.
Why the study?
It was unknown whether LDL-C levels influence the cardiovascular risk associated with non-aspirin NSAID use after myocardial infarction.
Does non-aspirin NSAID use increase the risk of MACE in adult patients with first-time MI, and is this risk influenced by baseline LDL-C levels?
Cohort (n=50,573)
Does non-aspirin NSAID use increase the risk of MACE in adult patients with first-time MI, and is this risk influenced by baseline LDL-C levels?
Hazard Ratio: 1.21 (95% CI 1.11–1.32)
In patients with prior MI, NSAID use is associated with an increased risk of MACE regardless of baseline LDL-C levels, although higher LDL-C may exacerbate the risk of all-cause death.
May support NSAID caution post-MI independent of LDL-C; leaves open causal confirmation in trials.
Aim: To examine whether low-density lipoprotein cholesterol (LDL-C) levels influence the cardiovascular risk associated with non-aspirin non-steroidal anti-inflammatory drug (NSAID) use after myocardial infarction (MI). Methods: Using Danish health registries, we conducted a population-based cohort study of all adult patients with first-time MI during 2010-2020 with an LDL-C value before discharge. Based on the latest LDL-C value, we categorized patients into a low and a high LDL-C group (<3.0 vs ≥3.0 mmol/L). We used time varying Cox regression to compute hazard ratios (HRs) with 95% confidence intervals of the association between NSAID use and a major adverse cardiovascular event (MACE: recurrent MI, ischemic stroke, and all-cause death). Results: We followed 50,573 patients for a median of 3.1 years. While exposed, 521 patients experienced a MACE: 312 in the low LDL-C group and 209 in the high LDL-C group. The HRs for MACE comparing NSAID use with non-use were 1.21 (1.11-1.32) overall, 1.19 (1.06-1.33) in the low LDL-C group, and 1.23 (1.07-1.41) in the high LDL-group. The HRs for recurrent MI and ischemic stroke were comparable between the LDL-C subgroups. The HRs for all-cause death were 1.22 (1.07-1.39) in the low LDL-C group and 1.54 (1.30-1.83) in the high LDL-C group. Changing the cut-off value for LDL-C to 1.8 and 1.4 mmol/L showed consistent results. Conclusion: In patients with MI, LDL-C levels did not influence the increased risk of MACE associated with NSAID use, but might influence the association between NSAID use and all-cause death.
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Basem et al. (2024) conducted a cohort in myocardial infarction (n=50,573). NSAID use vs. non-use was evaluated on major adverse cardiovascular event (MACE: recurrent MI, ischemic stroke, and all-cause death) (HR 1.21, 95% CI 1.11-1.32). In patients with prior MI, NSAID use was associated with an increased risk of MACE compared to non-use (HR 1.21; 95% CI 1.11-1.32), which was not influenced by baseline LDL-C levels.
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