Cardiovascular Risk Associated with the Use of Non Steroidal Anti-Inflammatory Drugs, Cases and Controls Study in a Health Care Area in Spain

Purpose: The purpose of this study is to evaluate cardiovascular impact related to the use of non steroidal anti-inflammatory drugs in a Health Care Area in Castilla La Mancha (Spain). Methodology: A retrospective observational study of clinical cases and controls during 5 years (2008-2012) is done, in which patients older than 18 years (n = 9.880) was included with acute coronary syndrome and randomly selected controls with pneumonia mathed for age, sex and calendar year. The statistical analysis was done estimating the incidence of acute coronary syndrome in relation to the exposure time. Results:The NSAID consumption is generally not associated with a risk of acute coronary syndrome (odds ratio = 1.07,IC95% 0.9-1.25, p<0.001). However, this risk is observed with diclofenac (odds ratio = 1.88, IC95% 1.6-2.22, p<0.001), higher doses than 1800 mg daily of ibuprofen (odds ratio = 1.60,IC95% 1.31-1.97, p<0.001) and celecoxib (odds ratio = 1.32, IC95% 1.11-1.46, p<0.001). With other anti-inflammatory drugs an increase of cardiovascular risk is not observed. Conclusion: Diclofenac, high doses of ibuprofen and celecoxib have been related to a risk of acute coronary syndrome, so it should be recommend taking low doses and for a short time of these drugs, especially in patients with a high cardiovascular risk.