Study links NSAIDs with higher risk of cardiac arrest

Short-term use of non-steroidal anti-inflammatory drugs (NSAIDs), particularly diclofenac and ibuprofen, has been linked with an increased risk of cardiac arrest in research published in European Heart Journal - Cardiovascular Pharmacotherapy.

The study looked at the Danish Cardiac Arrest Registry, which carries data on all patients who had an out-of-hospital cardiac arrest in Denmark between 2001 and 2010. Data was collected on all redeemed prescriptions for NSAIDs from Danish pharmacies since 1995, including the non-selective NSAIDs (diclofenac, naproxen, ibuprofen), and COX-2 selective inhibitors (rofecoxib, celecoxib).

A case-time-control design was then used to investigate the association between NSAID use and cardiac arrest, with each patient serving as both case and control in two different time periods to help remove the confounding effect of chronic comorbidities. NSAID use during the 30 days before cardiac arrest (case period) was compared to that during a preceding 30 day period without cardiac arrest (control period).

Researchers found 28,947 people who had suffered an out-of-hospital cardiac arrest, of whom 3,376 were treated with an NSAID in the preceding 30 days, with ibuprofen and diclofenac the most commonly used NSAIDs, accounting for 51 percent and 22 percent, respectively.

According to the study, use of any NSAID was associated with a 31 percent increased risk of cardiac arrest, with diclofenac and ibuprofen linked with a 50 percent and 31 percent increased risk, respectively. Naproxen, celecoxib and rofecoxib were not associated with the occurrence of cardiac arrest, possibly due to a low number of events.

"The findings are a stark reminder that NSAIDs are not harmless," stressed study author Professor Gunnar H. Gislason, professor of cardiology at Copenhagen University Hospital Gentofte, Denmark. "NSAIDs should be used with caution and for a valid indication. They should probably be avoided in patients with cardiovascular disease or many cardiovascular risk factors.

"Our study adds to the evidence about the adverse cardiovascular effects of NSAIDs and confirms that they should be taken seriously, and used only after consulting a healthcare professional," he added.