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Cardiology: NSAIDs May Increase the Risk of Atrial Fibrillation or Flutter

The study authors recommend physicians consider arrhythmia risks when prescribing NSAIDs

Use of non-selective non-steroidal anti-inflammatory drugs (NSAIDs) and selective COX-2 inhibitors is associated with an increased risk of atrial fibrillation (AF) or flutter, according to the results of a study published recently on the BMJ website. The study authors recommend that physicians consider the arrhythmia risks in addition to other cardiovascular risks when prescribing these drugs.

The authors write that any confirmed association between NSAID use and atrial fibrillation would have major clinical and public health implications, especially for older people because they tend to use NSAIDs frequently and the prevalence of atrial fibrillation increases with age. Finding limitations with existing literature, the researchers undertook the current study to examine the risks associated with the use of non-selective NSAIDs or COX-2 inhibitors via a population based case-control study using data from Danish medical databases.

The authors identified 32,602 patients with a first inpatient or outpatient hospital diagnosis of AF or flutter between 1999 and 2008. They compared these patients with 325,918 age- and sex-matched controls. The main outcome measures were exposure to NSAIDs at the time of (current use) or before (recent use) admission. Current use was further defined as new use (first-ever prescription redemption within 60 days of diagnosis) or long-term use (61 to 365 days prior to diagnosis).

A total of 2,925 cases (9 percent) and 21,871 controls (7 percent) were current users of either non-selective NSAIDs or COX-2 inhibitors. Compared with no use, the incidence rate ratio associating current drug use with AF or flutter was 1.33 for non-selective NSAIDs and 1.50 for COX-2 inhibitors. After adjusting for age, sex, and risk factors for AF and flutter, the incidence rate ratio fell to 1.27 and 1.46, respectively. Among new users, however, the adjusted incidence rate ratio was 1.46 for non-selective NSAIDs and 1.71 for COX-2 inhibitors. The authors conclude that the current study “adds evidence that atrial fibrillation or flutter need to be added to the cardiovascular risks under consideration when prescribing NSAIDs.”

Source: Schmidt M, Christiansen CF, Mehnert F, et al. 2011. Non-steroidal anti-inflammatory drug use and risk of atrial fibrillation or flutter: population based case-control study. Published on July 4, 2011 on the BMJ website.