Increased risk of myocardial infarction as first manifestation of ischaemic heart disease and nonselective nonsteroidal anti-inflammatory drugs

C Hawkey

G Hawkey

S Everitt

M Skelly

W Stack

D Gray

Wolfson Digestive Diseases Centre, Institute of Clinical Research, University Hospital, Nottingham, UK

^{Division of Cardiovascular Medicine, University Hospital, Nottingham, UK}

Correspondence Professor C. J. Hawkey, DM, FRCP, FMedSci, Wolfson Digestive Diseases Centre University Hospital, Nottingham NG7 2UH, UK. Tel: + 44 115 8231033 Fax: + 44 115 942232 E-mail: ku.ca.mahgnitton@yekwah.jc

Wolfson Digestive Diseases Centre, Institute of Clinical Research, University Hospital, Nottingham, UK

Received 2005 Aug 5; Accepted 2005 Dec 6.

Abstract

Aims

Selective cyclooxygenase (COX)-2 inhibitors have recently been implicated as enhancing risk of myocardial infarction (MI). Nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) are also effective COX-2 inhibitors, so we investigated the hypothesis that they too increase risk of MI.

Methods

We conducted a case–control study with direct structured interview of cases and controls. Cases were all subjects (N = 205) with a first nonfatal MI who had no previously recognized cardiovascular disease. Community controls (N = 258) were randomly selected from the same practice as the index case. Hospital controls (N = 205) were those admitted at the same time as index cases for nonmyocardial conditions not influenced by NSAID use. The effects of aspirin, NSAIDs and previously recognized influences on MI were investigated by unconditional logistic regression analysis.

Results

NSAID use was associated with an increase risk of MI with an odds ratio of 1.77 (1.03, 3.03) vs. community controls and 2.61 (1.38, 4.95) vs. hospital controls. These values were 5.00 (1.18, 21.28) and 7.66 (0.87, 67.48), respectively, in aspirin users. Results were similar when naproxen was grouped with aspirin. Odds ratios for smoking and for use of antidiabetic medication were 3.91 (2.52, 6.04) and 3.92 (1.25, 12,33), respectively, vs. community controls.

Conclusions

Like nonselective NSAIDs, selective COX-2 inhibitors are associated with an increased risk of MI. The extent to which this reflects interference with aspirin warrants further investigation.

Keywords: aspirin, case–control, epidemiology, myocardial infarction, non-steroidal anti-inflammatory drugs, smoking

Abstract

ICD, International Classification of Diseases; COPD, chronic obstructive pulmonary disease.

NSAID, Nonsteroidal anti-inflammatory drug.

Acknowledgments

The study was supported by an unrestricted grant from Boehringer Ingleheim Limited. The authors thank Mrs Yola Booth for preparing this manuscript.

Acknowledgments

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