Over the last decade, evidence supporting a possible link between the use of non-steroidal anti-inflammatory drugs (NSAIDs) and risk for myocardial infarction (MI) and stroke has been trickling into the scientific literature.
But until recently, little was understood about the timing of cardiovascular risk after NSAID exposure. Nor was it known whether the risk increased with higher doses or longer durations, or whether certain NSAIDs were associated with lower risk compared to others.
Unfortunately, most randomized control trials have been insufficiently powered to pick up the relatively small event rates, or they deliberately excluded patients at high cardiovascular risk. As a result, most of what we understood about the dangers of NSAID use came from secondary end points or subgroup analysis of the trials.
Recognizing the heightened risk, in 2015, the FDA reinforced warning labeling on NSAIDs to better reflect the risk for MI or strokes — even with only a short course of therapy.1 But it was unknown for how long a course of NSAIDs was needed to tip a patient into the danger zone.
If a patient took one dose for a headache, was he or she at elevated risk? Was that risk the same if the NSAID was taken daily for a week? Did the dose of the drug make a difference?
Because few trials had looked at the risk in real world populations, the answers to those questions remained unknown — until now.
Earlier this month, Dr Michèle Bally and colleagues sought to answer those questions in an article published in BMJ. They wanted to determine what dose and duration of NSAIDs was associated with an elevated risk of MI, while evaluating the timing of acute MI and/or strokes post-exposure.2