European Heart Journal Advance Access originally published online on May 26, 2006
European Heart Journal 2006 27(14):1657-1663; doi:10.1093/eurheartj/ehl053
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NSAID use and the risk of hospitalization for first myocardial infarction in the general population: a nationwide case–control study from Finland
1 Centre for Pharmacotherapy Development and Postgraduate School of Clinical Drug Research, University of Turku, PB 55, FIN-00301 Helsinki, Finland
2 Research Department, Social Insurance Institution, Peltolantie 2, FIN-20720 Turku, Finland
3 Department of Medicine, Turku University Hospital, PB 52, FIN-20521 Turku, Finland
4 Department of Emergency, Turku University Hospital and Department of Surgery, University of Turku, PB 52, FIN-20521 Turku, Finland
5 Research Department, Social Insurance Institution, PB 450, FIN-00101 Helsinki, Finland
6 Council for International Organizations of Medical Sciences, c/o WHO, CH-1211, Geneva 27, Switzerland
7 Department of Pharmacology and Clinical Pharmacology, University of Turku and Department of Pharmacology and Toxicology, University of Kuopio and Kuopio University Hospital, PB 1627, FIN-70211 Kuopio, Finland
Received 20 February 2006; revised 4 May 2006; accepted 6 May 2006; online publish-ahead-of-print 26 May 2006.
* Corresponding author. Tel: +358 9 4733 4429; fax: +358 9 4733 4431. E-mail address: arja.helin-salmivaara{at}rohto.fi
See page 1635 for the editorial comment on this article (doi:10.1093/eurheartj/ehl090)
Aims To evaluate the risk of first myocardial infarction (MI) associated with the use of various non-steroidal anti-inflammatory drugs (NSAIDs) in the general population.
Methods and results We conducted a population-based matched case–control study over the years 2000–3 in outpatient residents of Finland. In the nationwide Hospital Discharge Register 33 309 persons with first time MI were identified. A total of 138 949 controls individually matched for age, gender, hospital catchment area, and index day were selected from the Population Register. For combined NSAIDs, the adjusted odds ratio for the risk of first MI with current use was 1.40 (95% CI, 1.33–1.48). The risk was similar for conventional (1.34; 1.26–1.43), semi-selective (etodolac, nabumetone, nimesulide, and meloxicam) (1.50; 1.32–1.71), and cyclo-oxygenase-2 (COX-2) selective NSAIDs (rofecoxib, celecoxib, valdecoxib, and etoricoxib) (1.31; 1.13–1.50). Age of current user did not consistently modify the risk. No NSAID was associated with an MI-protective effect. All durations from 1 to 180 days of conventional NSAIDs and from 31 to 90 days duration of COX-2 selective NSAIDs were associated with an elevated risk of MI.
Conclusion Current use of all NSAIDs is associated with a modest risk of first time MI.
Key Words: Risk • Non-steroidal anti-inflammatory drugs • Myocardial infarction • Case–control
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