Even since rofexocib (Vioxx ®) was voluntarily recalled, physicians are increasingly more wary about the use of NSAIDs (non-steroidal anti-inflammatory drugs) in patients with heart disease. A new study published in Circulation suggests that any NSAID use should be limited in patients with cardiovascular disease.
In patients who have already had a heart attack, the use of NSAIDs is associated with increased risk of another heart attack and death. The increased risk was not only present at the start of treatment, but persisted the entire time the patient was taking a NSAID. The highest risk was with diclofenac (Volaren ®); ibuprofen (Motrin ®, Advil ®) showed an increased risk after use for more than one week. Naproxen (Naprosyn ®, Aleve ®) was not associated with an increased risk of death or MI for the entire treatment duration, but was associated with more gastrointestinal bleeding risk.
This was a large study of more than 80,000 patients from Denmark. The authors concluded that there is no safe therapeutic window for NSAID treatment.
This is another opportunity to remind patients that all medications are important, including over the counter products. Patients will sometimes neglect to mention seemingly trivial products and physicians are not always diligent in updating medication lists. Patients should be sure to apprise all treating physicians of all medical problems, even though it might seem irrelevant to the current situation.
Circulation. 2011;123:2226-2235
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