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Diclofenac and acute myocardial infarction in patients with no major risk factors
Author(s) -
Jick Susan S.,
Kaye James A.,
Jick Hershel
Publication year - 2007
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/j.1365-2125.2007.02942.x
Subject(s) - rofecoxib , medicine , diclofenac , celecoxib , ibuprofen , myocardial infarction , naproxen , medical prescription , anesthesia , relative risk , cyclooxygenase , pharmacology , confidence interval , biochemistry , chemistry , alternative medicine , pathology , enzyme
What is already known about this subject • We recently published the results of a study on the risk of acute myocardial infarction (AMI) in users of five nonsteroidal anti‐inflammatory drugs during the years 2001 to 2005. • The results demonstrated, as has been reported in randomized trials, that rofecoxib and celecoxib increase the risk of AMI when taken for at least 10 months. • As expected, ibuprofen and naproxen did not materially increase the risk. • However, long‐term users of diclofenac were at an increased risk of AMI similar to that of users of rofecoxib and celecoxib. What this study adds • Extensive use of diclofenac, similarly to rofecoxib and celecoxib, substantially increases the risk of AMI. • There is little suggestion of such an effect in users of ibuprofen and naproxen. Aims To explore further a recent finding that long‐term users of diclofenac are at increased risk of acute myocardial infarction (AMI) similar to users of rofecoxib and celecoxib. Methods Using the General Practice Research Database, we conducted three separate nested case–control studies of three nonsteroidal anti‐inflammatory drugs (NSAIDs) where use started after 1 January 1993 — diclofenac, ibuprofen and naproxen. Cases of AMI were identified between 1 January 1993 and 31 December 2000. Relative risk (RR) estimates for AMI in patients with no major clinical risk factors were determined for each NSAID according to number of prescriptions received compared with one prescription. Results were adjusted for variables possibly related to risk of AMI. Results There was no material elevation of AMI risk according to the number of prescriptions for ibuprofen [RRs and 95% confidence intervals (CIs) 1.0 (0.6, 1.6) and 1.7 (0.9, 3.1) for use of 10–19 and 20+ prescriptions, respectively, compared with one prescription] or naproxen [RRs 1.0 (0.5, 2.2) and 2.0 (0.9, 4.5) for use of 10–19 and 20+ prescriptions, respectively]. However, a substantial increased risk similar to that obtained in our prior study was found in patients who received ≥10 prescriptions for diclofenac [RRs 1.9 (1.3, 2.7) and 2.0 (1.3, 3.0) for use of 10–19 and 20+ prescriptions, respectively]. Conclusions Extensive use of diclofenac substantially increases the risk of AMI. There is little suggestion of such an effect in users of ibuprofen and naproxen.