The effects of nonselective non-aspirin non-steroidal anti-inflammatory medications on the risk of nonfatal myocardial infarction and their interaction with aspirin
Key result
NANSAIDs linked to ~47% lower MI risk in non-aspirin users but blunt concurrent aspirin cardioprotection.
- OR 0.53
- 95% CI 0.42 to 0.67
Why the study?
Non-aspirin non-steroidal anti-inflammatory drugs (NANSAIDs) may reduce myocardial infarction risk but may also interfere with aspirin's cardioprotective effect.
Population
Cases of first nonfatal MI and community controls
Comparison
NANSAID use vs no NANSAID use, aspirin use vs no aspirin use
Design
Case-control study
Authors
Discussion
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Implication
Case-control study observes reduced nonfatal myocardial infarction odds with non-aspirin NSAIDs but attenuated aspirin cardioprotection with concurrent use, indicating competitive drug interactions.
Key Points
- Determine whether non-aspirin non-steroidal anti-inflammatory drugs (NANSAIDs) reduce the odds of nonfatal myocardial infarction and assess whether they interfere with aspirin's cardioprotective effect.
- Conducted a case-control study prospectively identifying cases with a first nonfatal myocardial infarction alongside randomly selected community controls.
- Evaluated exposure and frequency of use for aspirin, nonselective NANSAIDs, ibuprofen, and naproxen to analyze individual and interaction effects.
- NANSAID use without aspirin was associated with reduced odds of myocardial infarction (adjusted OR 0.53; 95% CI: 0.42 to 0.67), with reductions observed for ibuprofen (adjusted OR 0.52; 95% CI: 0.39 to 0.69) and naproxen (adjusted OR 0.48; 95% CI: 0.28 to 0.82).
- Aspirin reduced myocardial infarction odds in non-NANSAID users (adjusted OR 0.79; 95% CI: 0.63 to 0.98), but provided no protective benefit among concurrent NANSAID users (OR 1.28; 95% CI: 0.85 to 1.94; p for interaction = 0.026).
- Frequent NANSAID use (at least four times weekly) significantly diminished aspirin's protective association (interaction p = 0.006; OR for aspirin vs. no aspirin 2.04; 95% CI: 1.06 to 3.94), especially with ibuprofen (p = 0.018).
Study Design
Type
Case-Control
PICO
P
Population
Cases of first, nonfatal MI identified prospectively and controls identified randomly from the community.
E
Exposure / Comparator
Non-aspirin non-steroidal anti-inflammatory drugs (NANSAIDs) vs No NANSAID use
O
Primary Outcome
First, nonfatal myocardial infarction — OR 0.53 (0.42 to 0.67)
Main Result
Odds Ratio: 0.53 (95% CI 0.42–0.67)
Cite This Study
Kimmel et al. (2004) conducted a case-control in First, nonfatal myocardial infarction. Non-aspirin non-steroidal anti-inflammatory drugs (NANSAIDs) vs. No NANSAID use was evaluated on First, nonfatal myocardial infarction (OR 0.53, 95% CI 0.42 to 0.67). Use of NANSAIDs was associated with reduced odds of MI among non-aspirin users (OR 0.53; 95% CI 0.42-0.67), but diminished aspirin's cardioprotective effect when used concurrently.