NSAID use and association with cardiovascular outcomes in outpatients with stable atherothrombotic disease

Published

Journal Article

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) other than aspirin have been linked to heart failure, salt retention, adverse ventricular remodeling, and thrombosis. We therefore sought to assess their impact on cardiovascular events in outpatients with stable atherothrombotic disease. Methods: We analyzed 44,095 patients in the REduction of Atherothrombosis for Continued Health (REACH) registry with information on NSAID use and 4-year follow-up. Cox proportional hazard models, including NSAID use as a time-dependent covariate, were constructed and adjusted for key baseline characteristics. End points of interest included multivariate adjusted: cardiovascular death/myocardial infarction/stroke/ischemic hospitalizations; cardiovascular death/myocardial infarction/stroke; hospitalization for heart failure; and individual components of the composite end points. Results: Compared with NSAID nonusers (n = 39,675), NSAID users (n = 4420) were older (70 vs 68 years), more frequently female and white, and had more baseline heart failure and atherosclerotic risk factors (hypertension, dyslipidemia, diabetes, reduced creatinine clearance) (all P <.001). NSAID use was associated with an increased hazard for cardiovascular death/myocardial infarction/stroke/ischemic hospitalizations (adjusted hazard ratio [adj. HR] 1.12; 95% confidence interval [CI], 1.04-1.21; P =.003) and for cardiovascular death/myocardial infarction/stroke (adj. HR 1.16; 95% CI, 1.03-1.30; P =.02). There also was a higher risk of myocardial infarction (adj. HR 1.37; 95% CI, 1.12-1.68; P =.002), stroke (adj. HR 1.21; 95% CI, 1.00-1.45; P =.048), heart failure hospitalizations (adj. HR 1.18; 95% CI, 1.03-1.34; P =.013), and ischemic hospitalizations (adj. HR 1.17; 95% CI, 1.07-1.27; P =.001). Conclusion: Among patients with stable atherothrombosis, NSAID use is associated with a higher risk of myocardial infarction, stroke, and hospitalizations for both ischemia and heart failure. © 2014 Elsevier Inc. All rights reserved.

Full Text

Duke Authors

Cited Authors

  • Kohli, P; Steg, PG; Cannon, CP; Smith, SC; Eagle, KA; Ohman, EM; Alberts, MJ; Hoffman, E; Guo, J; Simon, T; Sorbets, E; Goto, S; Bhatt, DL

Published Date

  • January 1, 2014

Published In

Volume / Issue

  • 127 / 1

Electronic International Standard Serial Number (EISSN)

  • 1555-7162

International Standard Serial Number (ISSN)

  • 0002-9343

Digital Object Identifier (DOI)

  • 10.1016/j.amjmed.2013.08.017

Citation Source

  • Scopus