Patients should not stop taking the drugs involved non-steroidal anti-inflammatory drugs (NSAIDS) but further investigation into these treatments is needed, say the authors.

In the biggest study of its kind to date, researchers identified 9,218 patients across England, Scotland and Wales who suffered a heart attack for the first time over a four year period. Patients ranged in age from 25 to 100.

Researchers looked at the prescribing patterns for these patients, tracking whether and when they had been prescribed NSAIDS. NSAIDS are commonly prescribed to relieve inflammation and pain, and include ibuprofen, diclofenac, naproxen, celecoxib and rofecoxib, plus a host of other less commonly prescribed anti-inflammatories.

The findings were adjusted to allow for several other heart attack risk factors including age, obesity, and smoking habits. Importantly, they also adjusted for whether the patient already suffered from heart disease, or whether they were being prescribed aspirin.

Researchers found that for those prescribed NSAIDS in the three months just before the heart attack, the risk increased compared with those who had not taken these drugs in the previous three years. For ibuprofen, the risk increased by almost a quarter (24%), and for diclofenac it rose by over a half (55%).

The newer generation of anti-inflammatories - COX-2 inhibitors - were also associated with increased rates of first-time heart attack. Those prescribed the drugs in the preceeding three months were at 21% higher risk of heart attack if taking celecoxib, and 32% increased risk if taking rofecoxib.

Since this study was concluded rofecoxib has already been withdrawn following concerns over heart attack risk. This is all the more important for the impact of this study on patients, say the
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Contact: Emma Dickinson
edickinson@bmj.com
44-207-383-6529
BMJ-British Medical Journal
9-Jun-2005