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Discontinuation of Nonsteroidal Anti-inflammatory Drug Therapy and Risk of Acute Myocardial Infarction
Lorenz M. Fischer, MSc;
Raymond G. Schlienger, PhD, MPH;
Christian M. Matter, MD;
Hershel Jick, MD;
Christoph R. Meier, PhD, MSc
Arch Intern Med. 2004;164:2472-2476.
Background Systemic inflammation has been shown to be associated with an increased risk of acute myocardial infarction (AMI). However, the effect of the use of nonsteroidal anti-inflammatory drugs (NSAIDs) on the risk of AMI has not yet been well defined. We therefore studied the risk of AMI during NSAID exposure and after the cessation of NSAID therapy.
Methods We conducted a large case-control analysis on the British General Practice Research Database. The study included 8688 cases with a first-time AMI between 1995 and 2001 and 33 923 controls, matched to cases on age, sex, calendar time, and general practice attended.
Results After adjusting for hypertension, hyperlipidemia, diabetes mellitus, ischemic heart disease, rheumatoid arthritis, systemic lupus erythematosus, acute chest infection, body mass index, smoking, and aspirin use, the risk of AMI was 1.52 (95% confidence interval [CI], 1.33-1.74) for subjects who stopped taking NSAIDs 1 to 29 days prior to the index date, compared with nonusers. The risk was highest in subjects with rheumatoid arthritis or systemic lupus erythematosus (adjusted OR, 3.68 [95% CI, 2.36-5.74]) and for subjects who discontinued therapy with NSAIDs after previous long-term use (adjusted OR, 2.60 [95% CI, 1.84-3.68]). Current and past NSAID use (discontinued therapy  60 days prior to the index date) were not associated with an increased risk of AMI (adjusted OR, 1.07 [95% CI, 0.96-1.19] and 1.05 [95% CI, 0.99-1.12], respectively).
Conclusion Our findings suggest that the risk of AMI is increased during several weeks after the cessation of NSAID therapy.
Author Affiliations: Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland (Mr Fischer and Drs Schlienger and Meier); Cardiovascular Research, Institute of Physiology, University of Zurich, and Division of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (Dr Matter); and Boston Collaborative Drug Surveillance Program, Boston University Medical Center, Lexington, Mass (Drs Jick and Meier).
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