The exact mechanism by which nonsteroidal anti-inflammatory drugs (NSAIDs) may increase
coronary risk is not completely understood. The aim of this study was to quantify
the risk for each type of acute coronary syndrome (ACS) associated using NSAIDs and
the role played by dose, duration, and patient characteristics. A prospective case-control
study was performed, interviewing 2,954 patients hospitalized for ACS at 32 Spanish
hospitals and a similar number of age-matched controls using a structured questionnaire
collecting information on the use of NSAIDs, risk factors, and cardiovascular history.
Odds ratios (ORs) for any type and each ACS type were calculated adjusted for gender,
body mass index, other risk factors, and concomitant medications by conditional logistic
regression. The adjusted OR of ACS associated with the current use of NSAIDs was 1.16
(95% confidence interval [CI] 0.95 to 1.42). The risk was increased in patients consuming
high doses (OR 1.64, 95% CI 1.06 to 2.53) and those with previous ischemic heart disease
(OR 1.84, 95% CI 1.13 to 3.00). The hazard was driven mostly by the increase in the
risk for non-ST-segment elevation ACS (OR 1.20, 95% CI 0.99 to 1.47), whereas NSAIDs
did not increase the risk for ST-segment elevation myocardial infarction (OR 1.00,
95% CI 0.80 to 1.26). In conclusion, the use of NSAIDs was associated with a small,
nonsignificant overall coronary risk that was more apparent for non-ST-segment elevation
ACS. This risk was stronger when NSAIDs were used at high doses or in patients with
previous ischemic heart disease.
Copyright 2010 Elsevier Inc. All rights reserved.