Onset of acute myocardial infarction after use of non-steroidal anti-inflammatory drugs

Tarek A. Hammad, David J. Graham, Judy A. Staffa, Cynthia J. Kornegay, Gerald J. Dal Pan

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Purpose: To examine the association between cyclooxygenase-2 (COX-2) selective and traditional nonsteroidal anti-inflammatory drugs (NSAIDs) and incident acute myocardial infarction (AMI), and to address unanswered questions regarding the contour of risk over time. Methods: A cohort of new NSAID users aged 40-84 years was followed for the occurrence of first AMI. Data were collected within the General Practice Research Database (GPRD) from 1 January 1997 to 31 December 2004. Results: The study population included 1 185 AMI events (889 probable and 296 possible) from a cohort of 283 136 patients. After adjustment for demographic and cardiovascular risk factors, the hazard ratio (HR) for AMI was significantly increased for both coxib (2.11, 95% corifidence interval (CI) 1.04-4.26) and non-coxib (2.24, 95%CI 1.13-4A2) COX-2 selective NSAIDs when compared to remote exposure to NSAIDs, but was not increased for traditional NSAIDs. Stratifying exposure into the first month of use versus use beyond 1 month, the risk of AMI was increased during the flrst month of COX-2 selective NSAIDs use, but not later (3.43, 95%CI 1.66-7.07 and 1.88, 95%CI 0.82-4.31, respectively p-value for interaction = 0.6). Conclusions: The results suggest that the use of coxib and non-coxib COX-2 selective NSAIDs was associated with an elevated risk of AMI within the first month of exposure. Recent past exposure to NSAID was not associated with a similar increase in risk.

Original languageEnglish (US)
Pages (from-to)315-321
Number of pages7
JournalPharmacoepidemiology and Drug Safety
Issue number4
StatePublished - Apr 2008
Externally publishedYes


  • Acute myocardial infarction
  • New user design
  • Nonsteroidal anti-inflammatory drugs

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology, Toxicology and Pharmaceutics(all)


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