Researchers have found that NSAIDs pose the greatest heart attack risk in the first month of use.
Study leader Michèle Bally, of the University of Montreal Hospital Research Center in Canada, and colleagues recently reported their findings in The BMJ.
A number of studies have suggested that the use of certain nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk of heart attack.
So strong is this evidence that, in 2015, the U.S. Food and Drug Administration (FDA) strengthened their warning about the risk of heart attack with the use of over-the-counter and prescription NSAIDs.
However, Bally and colleagues note that previous studies looking at the risk of heart attack with NSAID use have been subject to various limitations, such as small sample sizes and lack of comparisons with a placebo.
As a result, the team says that these studies have failed to generate a solid understanding of which NSAID doses pose the greatest risk or how the length of use may impact heart attack risk.
Heart attack risk highest in first month of NSAID use
With the aim of closing this research gap, the team reviewed 82 studies that looked at the incidence of heart attack with NSAID use.
After screening the studies for eligibility, the researchers were left with eight studies that included a total of 446,763 men and women from Canada, Finland, and the United Kingdom. Of these individuals, 61,460 had experienced a heart attack.
The researchers looked at the NSAID use of each participant, focusing on specific types, including ibuprofen, diclofenac, celecoxib, rofecoxib, and naproxen.
Overall, the team found that individuals who used any of these NSAIDs at any dose for at least 1 week had a 20 to 50 percent increased risk of heart attack, compared with individuals who did not use NSAIDs.
Looking at heart attack risk by individual NSAID use, the researchers identified a possible 100 percent increased risk with rofecoxib, and a possible 75 percent increased risk for both ibuprofen and naproxen.
The team uncovered evidence that suggests the first month of NSAID use poses the highest risk of heart attack, particularly if the drugs are taken at high doses.
Prescribers 'should weigh the benefits and risks of NSAIDs'
The researchers note that their study is purely observational, so it is unable to make any conclusions about cause and effect between NSAID use and risk of heart attack.
That said, they say that the type of analysis they conducted allowed them to conclude with 90 percent certainty that the use of NSAIDs raises the risk of heart attack.
The authors conclude:
"In summary, compared with non-use of NSAIDs in the preceding year, we documented that current use of all studied NSAIDs, including naproxen, was associated with an increased risk of acute myocardial infarction.
Given that the onset of risk of acute myocardial infarction occurred in the first week and appeared greatest in the first month of treatment with higher doses, prescribers should consider weighing the risks and benefits of NSAIDs before instituting treatment, particularly for higher doses."