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NSAIDs & Myocardial Infraction Risk--only ASPIRIN is safe
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PLAVIX HAS SERIOUS SIDE EFFECTS--ASPIRIN PREFERRED

Carefully controlled study show that all class of non-aspirin NSAIDs cause increased risk of myocardial infraction. 

 

 

ARCHIVES OF INTERNAL MEDICINE,  Vol. 165 No. 9. May 9, 2005

 

Risk of Hospitalization for Myocardial Infarction Among Users of Rofecoxib, Celecoxib, and Other NSAIDs

A Population-Based Case-Control Study

Søren P. Johnsen, MD, PhD; Heidi Larsson, MSc; Robert E. Tarone, PhD; Joseph K. McLaughlin, PhD; Bente Nørgård, MD, PhD; Søren Friis, MD; Henrik T. Sørensen, DMSc

Arch Intern Med. 2005;165:978-984.

Background  It remains uncertain if the excess cardiovascular risk of rofecoxib and celecoxib reported in clinical trials is present in routine practice and whether the use of other non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) also carries an increased cardiovascular risk. We performed a population-based case-control study to examine the risk of myocardial infarction (MI) among users of various categories of non-aspirin NSAIDs.

Methods  Using data from hospital discharge registries in the counties of North Jutland, Viborg, and Aarhus, Denmark, and the Danish Civil Registration System, we identified 10 280 cases of first-time hospitalization for MI and 102 797 sex- and age-matched non-MI population controls. All prescriptions for non-aspirin NSAIDs filled before the date of admission for MI were identified using population-based prescription databases. Relative risk estimates for MI were adjusted for a history of cardiovascular disease, hypertension, diabetes mellitus, chronic bronchitis or emphysema, alcoholism, liver cirrhosis, upper gastrointestinal bleeding, rheumatoid arthritis, systemic lupus erythematosus and the use of high-dose aspirin, platelet inhibitors, insulin or oral hypoglycemic drugs, antihypertensive drugs, lipid-lowering drugs, oral anticoagulants, nitrates, penicillamine, gold, oral glucocorticocoids, and hormone therapy before the date of admission for MI.

Results  Current users of rofecoxib had an elevated risk estimate for hospitalization for MI compared with nonusers of any category of non-aspirin NSAIDs (adjusted relative risk [ARR], 1.80; 95% confidence interval [CI], 1.47-2.21). Increased risk estimates were also found among current users of celecoxib (ARR, 1.25; 95% CI, 0.97-1.62), other cyclooxygenase-2 selective inhibitors (ARR, 1.45; 95% CI, 1.09-1.93), naproxen (ARR, 1.50; 95% CI, 0.99-2.29), and other conventional non-aspirin NSAIDs (ARR, 1.68; 95% CI, 1.52-1.85). The highest ARRs were found among new users of all examined drug categories.

Conclusions  Current and new users of all classes of non-aspirin NSAIDs had elevated relative risk estimates for MI. Although the increased risk estimates may partly reflect unmeasured bias, they indicate the need for further examination of the cardiovascular safety of all non-aspirin NSAIDs.


Author Affiliations: Department of Clinical Epidemiology, Aarhus Hospital, Aarhus University Hospital, Aarhus, Denmark (Drs Johnsen, Nørgård, and Sørensen and Ms Larsson); Center of Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark (Dr Johnsen); International Epidemiology Institute, Rockville, Md (Drs Tarone and McLaughlin); Department of Medicine, Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, Tenn (Drs Tarone and McLaughlin); and Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark (Dr Friis).


THERE IS A FUNDAMENTAL CONFUSION ABOUT BLEEDING.  ONE IS CAUSED BY PLATELET REDUCTION, THE OTHER BY IRRITATION TO THE GASTRO INTESTIONAL TRACK.  Aspirin and other NSAID cause stomach bleeding by the fact that they are corrosive.  Dissolve one on your tongue and you’ll taste the proof.  This confusion has been promoted by drug companies which have been marketing COX-2 inhibitors.  They claim that it is the platelet reduction caused by COX-1 reduction that produces GI incidents.  Wrong, it is the caustic nature of those drugs that produce GI incidences—the platelet reduction would then increase the amount of bleeding.  COX-1 inhibitors produce excessive bleeding that is why there ought not be taken prior to an operation or following one.   

 

Goodman & Gilman, 11th Ed.(690):  “Although aspirin is regarded as the standard against which other drugs should be compared for treatment of rheumatoid arthritis, many clinicians favor the use of other NSAIDs perceived to have better gastrointestinal tolerability, even though this perception remains unproven by convincing clinical trials.”  {As I pointed out, most test use a coated NSAID compared to an uncoated aspirin, and often at lower therapeutic dose.--jk}

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