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High-Dose Cox-2 Inhibitors, NSAIDs Risky for MI Patients

Higher death risk seen in myocardial infarction patients using high dosages

MONDAY, June 19 (HealthDay News) -- In patients who have previously had a myocardial infarction (MI), the use of high dosages of selective cyclooxygenase-2 (COX-2) inhibitors and other nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) carries an increased risk of mortality, according to a study published online June 19 in Circulation: Journal of the American Heart Association.

Gunnar H. Gislason, M.D., of Gentofte University Hospital in Hellerup, Denmark, and colleagues studied the association between the use of these drugs in high doses and the risk of death and rehospitalization for MI using data from nationwide Danish administrative registers on 58,432 patients with first-time MI between 1995 and 2002 and prescription claims for NSAIDs.

There were 9,773 patients rehospitalized for MI and 16,573 patients who died. Rofecoxib was prescribed to 5.2 percent of patients, while 4.3 percent received celecoxib, 17.5 percent received ibuprofen, 10.6 percent received diclofenac and 12.7 percent received other NSAIDs. Use of rofecoxib was associated with a 2.8 times higher risk of mortality, while for celecoxib, ibuprofen, diclofenac and other NSAIDs, the hazard ratios were 2.57, 1.50, 2.40 and 1.29, respectively. The mortality risk was dose-related for all drugs.

"The cardiovascular safety of not only the selective COX-2 inhibitors but of all NSAIDs needs to be addressed further," the authors conclude.

The study was supported by a grant from the Danish Pharmaceutical Association.

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