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Heart Disease

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Non-aspirin, nonsteroidal antiinflammatory drugs do not protect individuals from the risk of heart attack

Among older adults at risk for coronary heart disease, non-aspirin, nonsteroidal antiinflammatory drugs (NANSAIDs) such as naproxen and ibuprofen neither increase nor reduce the risk of heart attack, finds a new study. The absence of a cardioprotective effect from NANSAIDs suggests that none of these drugs should be used for cardioprotection, concludes Wayne A. Ray, Ph.D., of Vanderbilt University School of Medicine. Dr. Ray and his colleagues studied whether patients at risk for coronary heart disease who took NANSAIDs were hospitalized for heart attack less often than similarly at-risk patients who did not take NANSAIDs.

They analyzed data from the Tennessee Medicaid program from 1987 through 1998 to identify a group of nearly 200,000 new NANSAID users and an equal number of non-users, matched for age (50-84 years) and sex. Both groups were at high risk for serious coronary heart disease either due to hypertension, prior stroke, angina, or other problems. During the study period, 12 cases of heart attack occurred per 1,000 person-years. The likelihood of NANSAIDs reducing heart attack risk for current and former users of NANSAIDs was 1.05 and 1.02 (1 is equal odds). In other words, their risk was equal to that of nonusers.

Odds ratios for naproxen, ibuprofen, and other NANSAIDs were 0.95, 1.15, and 1.03, respectively. There was no protection among long-term NANSAID users with uninterrupted use or among current users with more than 60 days of continuous use (OR 1.05). A previous study had shown a substantially reduced risk of heart attack among patients who took naproxen compared with the NANSAID rofecoxib, which has been interpreted to mean that naproxen had a cardioprotective effect. This study did not find support for naproxen's protective effect.

More details are in "Non-steroidal anti-inflammatory drugs and risk of serious coronary heart disease: An observational cohort study," by Dr. Ray, Michael Stein, M.S., Kathi Hall, and others, in the January 12, 2002 Lancet 359, pp. 118-123.

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