Comparative Risks of Nonsteroidal Anti‐inflammatory Drugs on Cardiovascular Diseases: A Population‐Based Cohort Study

• Published in: Journal of clinical pharmacology 2023-01, Vol.63 (1), p.126-134
• Main Authors: Wan, Eric Yuk Fai, Yu, Esther Yee Tak, Chan, Linda, Mok, Anna Hoi Ying, Wang, Yuan, Chan, Esther Wai Yin, Wong, Ian Chi Kei, Lam, Cindy Lo Kuen
• Format: Article
• Language: English
• Subjects: Adult; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - chemically induced; Cardiovascular Diseases - epidemiology; Celecoxib; Cohort analysis; Cohort Studies; Congestive heart failure; Coronary artery disease; coronary heart disease; Diclofenac; Electronic medical records; Etoricoxib - adverse effects; Heart diseases; heart failure; Humans; Ibuprofen; Indomethacin; long‐term; Mefenamic acid; Naproxen; Nonsteroidal anti-inflammatory drugs; NSAID; Population studies; Population-based studies; Retrospective Studies; Risk Factors; stroke
• ISSN: 0091-2700; 1552-4604
• DOI: 10.1002/jcph.2142

Through examining the incidence of cardiovascular diseases (CVDs) among nonsteroidal anti‐inflammatory drug (NSAID) users and nonusers, this study aims to compare the risks contributed by different NSAIDs in a Chinese population. The retrospective cohort including 4 298 368 adults without CVD from electronic health records between 2008 and 2017 in Hong Kong was adopted. A total of 4.5% of individuals received NSAIDs including celecoxib, etoricoxib, diclofenac, ibuprofen, indomethacin, mefenamic acid, or naproxen for ≥4 consecutive weeks at baseline. Cox regression, including NSAID use as a time‐dependent covariate and adjusted with patient's characteristics, was conducted to examine the association between NSAID exposure and incident CVD. After a median follow‐up of 6.9 years (30 million person‐years), a total of 258 601 cases of incident CVD was recorded. NSAID use was shown to be associated with a significantly higher risk of CVD (hazard ratio [HR], 1.32 [95%CI, 1.28–1.37]) compared to non‐NSAID use. Similar results in coronary heart disease (HR, 1.37 [95%CI, 1.31–1.43]), stroke (HR, 1.27 [95%CI, 1.21–1.33]), and heart failure (HR, 1.25 [95%CI, 1.16–1.34]) were obtained. Overall, similar CVD risk was observed across users of NSAIDs except for etoricoxib, which showed a higher risk (HR, 2.01 [95%CI, 1.63–2.48]). Considering that a higher CVD risk was consistently displayed among NSAID users, NSAIDs should be used cautiously, and the usage of etoricoxib in the Chinese population should be reviewed.