Medical News: Study Finds CV Risk Even With Short-Term NSAID Use - in Cardiovascular, Myocardial Infarction Source: MedPage Today

[Guest guest]

http://www.medpagetoday.com/Cardiology/MyocardialInfarction/pda/26412

Study Finds CV Risk Even With Short-Term NSAID Use

By Peggy Peck, Executive Editor, MedPage Today

Reviewed by Jasmer, MD; Associate Clinical Professor of Medicine,

University of California, San Francisco

Action Points

Explain that there is no " safe " duration for NSAID use in patients with a

history of MI, and the use of NSAIDs after MI increased the relative risk of

death or second MI by as much as 45%.

Note that the common NSAID diclofenac (Voltaren, Cataflam) was associated with a

3.52 hazard ratio for death during the first week of use, a higher risk of death

at the initiation of treatment than was seen with Vioxx.

There is no " safe " duration for NSAID use in patients with a history of

myocardial infarction, according to an analysis of data from more than 83,000

patients -- use of NSAIDs after MI increased the relative risk of death or

second MI by as much as 45%.

Moreover, the common NSAID diclofenac (Voltaren, Cataflam) was associated with a

3.52 HR for death during the first week of use, according to Anne-Marie

Schjerning Olsen, MB, of Copenhagen University Hospital in Gentofte, Denmark,

and colleagues.

That's a higher risk of death at the initiation of treatment than was seen with

rofecoxib (Vioxx), which was withdrawn from the market in 2004, they wrote

online in Circulation, Journal of the American Heart Association.

" Our data challenge the current recommendation by the American Heart Association

regarding NSAID treatment in patients with established cardiovascular disease,

because we demonstrate that even short-term NSAID treatment is associated with

increased cardiovascular risk in patients with prior MI; i.e., there essentially

appears to be no safe therapeutic window for NSAID treatment, " they concluded.

Denmark maintains detailed records of patient admissions, re-admissions, and

medication use as well as a central death registry. Using those databases,

Schjerning Olsen and her colleagues were able to identify 83,675 patients who

were admitted to a hospital for treatment of a first MI over a 10 year period

(1997-2006) and were able to link those patients on an individual basis to

pharmacy records.

The mean age of patients was 68 and 63% of them were men.

During follow-up, 42.3% of the patients received NSAIDS and there were 35,257

deaths or recurrent MIs.

" In brief, overall NSAID treatment was associated with a statistically

significantly increased risk of death at the beginning of the treatment, and the

risk persisted throughout the course of treatment, " the researchers wrote.

Patients taking rofecoxib had an increase in risk of death after taking the drug

for a week to two weeks, while the other selective COX-2 inhibitor, celecoxib

(Celebrex) had an increased risk of death when treatment lasted two weeks to a

month.

Diclofenac " was associated with an increased risk from the beginning of

treatment and the risk persisted throughout the course of treatment. "

For ibuprofen, which was the most commonly used NSAID, the increased risk was

seen for treatment lasting more than a week.

Among the findings:

All NSAIDs increased risk of death or recurrent MI by 45% after a week (HR 1.45,

95% CI 1.29 to 1.62).

Naproxen increase the risk of death or recurrent MI by 76% after a week (HR

1.76, 95% CI 1.04 to 2.98), but for treatments lasting 30 to 90 days the risk

increased risk was 15% (HR 1.15, 95% CI 0.80 to 1.65).

Ibuprofen had the lowest initial risk, just a 4% increase for treatments lasting

seven days or less (HR 1.04, 95% CI 0.83 to 1.30).

The authors noted a number of limitations of the study, starting with its

observational design.

Moreover, they noted that they were not able to determine the " precise

indication for initiation of NSAID treatment. Thus, the disease or pain causing

a condition treated with an NSAID could alone indicate a condition with

increased risk of cardiovascular disease or death. "

Information bias was another potential limitation as " patients do not

necessarily take their medications consecutively, leading to the fact that the

prescription may run longer and the patients therefore are exposed later than

the database might indicate. "

The authors said that more randomized clinical trials are warranted but,

meanwhile, " the accumulating evidence suggests that we must limit NSAID use to

the absolute minimum in patients with established cardiovascular disease. "

The authors had no disclosures.

Take the Posttest

Primary source: Circulation

Source reference:

Schjerning Olsen AM, et al " Duration of treatment with nonsteroidal

anti-inflammatory drugs and impact on risk of death and recurrent myocardial

infarction in patients with prior myocardial infarction a nationwide cohort

study " Circulation 2011; DOI:10.1161/CIRCULATIONAHA.110.004671.

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[Guest guest]

http://www.medpagetoday.com/Cardiology/MyocardialInfarction/pda/26412

Study Finds CV Risk Even With Short-Term NSAID Use

By Peggy Peck, Executive Editor, MedPage Today

Reviewed by Jasmer, MD; Associate Clinical Professor of Medicine,

University of California, San Francisco

Action Points

Explain that there is no " safe " duration for NSAID use in patients with a

history of MI, and the use of NSAIDs after MI increased the relative risk of

death or second MI by as much as 45%.

Note that the common NSAID diclofenac (Voltaren, Cataflam) was associated with a

3.52 hazard ratio for death during the first week of use, a higher risk of death

at the initiation of treatment than was seen with Vioxx.

There is no " safe " duration for NSAID use in patients with a history of

myocardial infarction, according to an analysis of data from more than 83,000

patients -- use of NSAIDs after MI increased the relative risk of death or

second MI by as much as 45%.

Moreover, the common NSAID diclofenac (Voltaren, Cataflam) was associated with a

3.52 HR for death during the first week of use, according to Anne-Marie

Schjerning Olsen, MB, of Copenhagen University Hospital in Gentofte, Denmark,

and colleagues.

That's a higher risk of death at the initiation of treatment than was seen with

rofecoxib (Vioxx), which was withdrawn from the market in 2004, they wrote

online in Circulation, Journal of the American Heart Association.

" Our data challenge the current recommendation by the American Heart Association

regarding NSAID treatment in patients with established cardiovascular disease,

because we demonstrate that even short-term NSAID treatment is associated with

increased cardiovascular risk in patients with prior MI; i.e., there essentially

appears to be no safe therapeutic window for NSAID treatment, " they concluded.

Denmark maintains detailed records of patient admissions, re-admissions, and

medication use as well as a central death registry. Using those databases,

Schjerning Olsen and her colleagues were able to identify 83,675 patients who

were admitted to a hospital for treatment of a first MI over a 10 year period

(1997-2006) and were able to link those patients on an individual basis to

pharmacy records.

The mean age of patients was 68 and 63% of them were men.

During follow-up, 42.3% of the patients received NSAIDS and there were 35,257

deaths or recurrent MIs.

" In brief, overall NSAID treatment was associated with a statistically

significantly increased risk of death at the beginning of the treatment, and the

risk persisted throughout the course of treatment, " the researchers wrote.

Patients taking rofecoxib had an increase in risk of death after taking the drug

for a week to two weeks, while the other selective COX-2 inhibitor, celecoxib

(Celebrex) had an increased risk of death when treatment lasted two weeks to a

month.

Diclofenac " was associated with an increased risk from the beginning of

treatment and the risk persisted throughout the course of treatment. "

For ibuprofen, which was the most commonly used NSAID, the increased risk was

seen for treatment lasting more than a week.

Among the findings:

All NSAIDs increased risk of death or recurrent MI by 45% after a week (HR 1.45,

95% CI 1.29 to 1.62).

Naproxen increase the risk of death or recurrent MI by 76% after a week (HR

1.76, 95% CI 1.04 to 2.98), but for treatments lasting 30 to 90 days the risk

increased risk was 15% (HR 1.15, 95% CI 0.80 to 1.65).

Ibuprofen had the lowest initial risk, just a 4% increase for treatments lasting

seven days or less (HR 1.04, 95% CI 0.83 to 1.30).

The authors noted a number of limitations of the study, starting with its

observational design.

Moreover, they noted that they were not able to determine the " precise

indication for initiation of NSAID treatment. Thus, the disease or pain causing

a condition treated with an NSAID could alone indicate a condition with

increased risk of cardiovascular disease or death. "

Information bias was another potential limitation as " patients do not

necessarily take their medications consecutively, leading to the fact that the

prescription may run longer and the patients therefore are exposed later than

the database might indicate. "

The authors said that more randomized clinical trials are warranted but,

meanwhile, " the accumulating evidence suggests that we must limit NSAID use to

the absolute minimum in patients with established cardiovascular disease. "

The authors had no disclosures.

Take the Posttest

Primary source: Circulation

Source reference:

Schjerning Olsen AM, et al " Duration of treatment with nonsteroidal

anti-inflammatory drugs and impact on risk of death and recurrent myocardial

infarction in patients with prior myocardial infarction a nationwide cohort

study " Circulation 2011; DOI:10.1161/CIRCULATIONAHA.110.004671.

Sent via BlackBerry by AT & T

[Guest guest]

http://www.medpagetoday.com/Cardiology/MyocardialInfarction/pda/26412

Study Finds CV Risk Even With Short-Term NSAID Use

By Peggy Peck, Executive Editor, MedPage Today

Reviewed by Jasmer, MD; Associate Clinical Professor of Medicine,

University of California, San Francisco

Action Points

Explain that there is no " safe " duration for NSAID use in patients with a

history of MI, and the use of NSAIDs after MI increased the relative risk of

death or second MI by as much as 45%.

Note that the common NSAID diclofenac (Voltaren, Cataflam) was associated with a

3.52 hazard ratio for death during the first week of use, a higher risk of death

at the initiation of treatment than was seen with Vioxx.

There is no " safe " duration for NSAID use in patients with a history of

myocardial infarction, according to an analysis of data from more than 83,000

patients -- use of NSAIDs after MI increased the relative risk of death or

second MI by as much as 45%.

Moreover, the common NSAID diclofenac (Voltaren, Cataflam) was associated with a

3.52 HR for death during the first week of use, according to Anne-Marie

Schjerning Olsen, MB, of Copenhagen University Hospital in Gentofte, Denmark,

and colleagues.

That's a higher risk of death at the initiation of treatment than was seen with

rofecoxib (Vioxx), which was withdrawn from the market in 2004, they wrote

online in Circulation, Journal of the American Heart Association.

" Our data challenge the current recommendation by the American Heart Association

regarding NSAID treatment in patients with established cardiovascular disease,

because we demonstrate that even short-term NSAID treatment is associated with

increased cardiovascular risk in patients with prior MI; i.e., there essentially

appears to be no safe therapeutic window for NSAID treatment, " they concluded.

Denmark maintains detailed records of patient admissions, re-admissions, and

medication use as well as a central death registry. Using those databases,

Schjerning Olsen and her colleagues were able to identify 83,675 patients who

were admitted to a hospital for treatment of a first MI over a 10 year period

(1997-2006) and were able to link those patients on an individual basis to

pharmacy records.

The mean age of patients was 68 and 63% of them were men.

During follow-up, 42.3% of the patients received NSAIDS and there were 35,257

deaths or recurrent MIs.

" In brief, overall NSAID treatment was associated with a statistically

significantly increased risk of death at the beginning of the treatment, and the

risk persisted throughout the course of treatment, " the researchers wrote.

Patients taking rofecoxib had an increase in risk of death after taking the drug

for a week to two weeks, while the other selective COX-2 inhibitor, celecoxib

(Celebrex) had an increased risk of death when treatment lasted two weeks to a

month.

Diclofenac " was associated with an increased risk from the beginning of

treatment and the risk persisted throughout the course of treatment. "

For ibuprofen, which was the most commonly used NSAID, the increased risk was

seen for treatment lasting more than a week.

Among the findings:

All NSAIDs increased risk of death or recurrent MI by 45% after a week (HR 1.45,

95% CI 1.29 to 1.62).

Naproxen increase the risk of death or recurrent MI by 76% after a week (HR

1.76, 95% CI 1.04 to 2.98), but for treatments lasting 30 to 90 days the risk

increased risk was 15% (HR 1.15, 95% CI 0.80 to 1.65).

Ibuprofen had the lowest initial risk, just a 4% increase for treatments lasting

seven days or less (HR 1.04, 95% CI 0.83 to 1.30).

The authors noted a number of limitations of the study, starting with its

observational design.

Moreover, they noted that they were not able to determine the " precise

indication for initiation of NSAID treatment. Thus, the disease or pain causing

a condition treated with an NSAID could alone indicate a condition with

increased risk of cardiovascular disease or death. "

Information bias was another potential limitation as " patients do not

necessarily take their medications consecutively, leading to the fact that the

prescription may run longer and the patients therefore are exposed later than

the database might indicate. "

The authors said that more randomized clinical trials are warranted but,

meanwhile, " the accumulating evidence suggests that we must limit NSAID use to

the absolute minimum in patients with established cardiovascular disease. "

The authors had no disclosures.

Take the Posttest

Primary source: Circulation

Source reference:

Schjerning Olsen AM, et al " Duration of treatment with nonsteroidal

anti-inflammatory drugs and impact on risk of death and recurrent myocardial

infarction in patients with prior myocardial infarction a nationwide cohort

study " Circulation 2011; DOI:10.1161/CIRCULATIONAHA.110.004671.

Sent via BlackBerry by AT & T

[Guest guest]

http://www.medpagetoday.com/Cardiology/MyocardialInfarction/pda/26412

Study Finds CV Risk Even With Short-Term NSAID Use

By Peggy Peck, Executive Editor, MedPage Today

Reviewed by Jasmer, MD; Associate Clinical Professor of Medicine,

University of California, San Francisco

Action Points

Explain that there is no " safe " duration for NSAID use in patients with a

history of MI, and the use of NSAIDs after MI increased the relative risk of

death or second MI by as much as 45%.

Note that the common NSAID diclofenac (Voltaren, Cataflam) was associated with a

3.52 hazard ratio for death during the first week of use, a higher risk of death

at the initiation of treatment than was seen with Vioxx.

There is no " safe " duration for NSAID use in patients with a history of

myocardial infarction, according to an analysis of data from more than 83,000

patients -- use of NSAIDs after MI increased the relative risk of death or

second MI by as much as 45%.

Moreover, the common NSAID diclofenac (Voltaren, Cataflam) was associated with a

3.52 HR for death during the first week of use, according to Anne-Marie

Schjerning Olsen, MB, of Copenhagen University Hospital in Gentofte, Denmark,

and colleagues.

That's a higher risk of death at the initiation of treatment than was seen with

rofecoxib (Vioxx), which was withdrawn from the market in 2004, they wrote

online in Circulation, Journal of the American Heart Association.

" Our data challenge the current recommendation by the American Heart Association

regarding NSAID treatment in patients with established cardiovascular disease,

because we demonstrate that even short-term NSAID treatment is associated with

increased cardiovascular risk in patients with prior MI; i.e., there essentially

appears to be no safe therapeutic window for NSAID treatment, " they concluded.

Denmark maintains detailed records of patient admissions, re-admissions, and

medication use as well as a central death registry. Using those databases,

Schjerning Olsen and her colleagues were able to identify 83,675 patients who

were admitted to a hospital for treatment of a first MI over a 10 year period

(1997-2006) and were able to link those patients on an individual basis to

pharmacy records.

The mean age of patients was 68 and 63% of them were men.

During follow-up, 42.3% of the patients received NSAIDS and there were 35,257

deaths or recurrent MIs.

" In brief, overall NSAID treatment was associated with a statistically

significantly increased risk of death at the beginning of the treatment, and the

risk persisted throughout the course of treatment, " the researchers wrote.

Patients taking rofecoxib had an increase in risk of death after taking the drug

for a week to two weeks, while the other selective COX-2 inhibitor, celecoxib

(Celebrex) had an increased risk of death when treatment lasted two weeks to a

month.

Diclofenac " was associated with an increased risk from the beginning of

treatment and the risk persisted throughout the course of treatment. "

For ibuprofen, which was the most commonly used NSAID, the increased risk was

seen for treatment lasting more than a week.

Among the findings:

All NSAIDs increased risk of death or recurrent MI by 45% after a week (HR 1.45,

95% CI 1.29 to 1.62).

Naproxen increase the risk of death or recurrent MI by 76% after a week (HR

1.76, 95% CI 1.04 to 2.98), but for treatments lasting 30 to 90 days the risk

increased risk was 15% (HR 1.15, 95% CI 0.80 to 1.65).

Ibuprofen had the lowest initial risk, just a 4% increase for treatments lasting

seven days or less (HR 1.04, 95% CI 0.83 to 1.30).

The authors noted a number of limitations of the study, starting with its

observational design.

Moreover, they noted that they were not able to determine the " precise

indication for initiation of NSAID treatment. Thus, the disease or pain causing

a condition treated with an NSAID could alone indicate a condition with

increased risk of cardiovascular disease or death. "

Information bias was another potential limitation as " patients do not

necessarily take their medications consecutively, leading to the fact that the

prescription may run longer and the patients therefore are exposed later than

the database might indicate. "

The authors said that more randomized clinical trials are warranted but,

meanwhile, " the accumulating evidence suggests that we must limit NSAID use to

the absolute minimum in patients with established cardiovascular disease. "

The authors had no disclosures.

Take the Posttest

Primary source: Circulation

Source reference:

Schjerning Olsen AM, et al " Duration of treatment with nonsteroidal

anti-inflammatory drugs and impact on risk of death and recurrent myocardial

infarction in patients with prior myocardial infarction a nationwide cohort

study " Circulation 2011; DOI:10.1161/CIRCULATIONAHA.110.004671.

Sent via BlackBerry by AT & T