Watch out for the ibuprofen if you are older with high blood pressure or coronary artery disease

Older patients with hypertension and coronary artery disease who use NSAIDs for chronic pain are at significantly increased risk of cardiovascular events, a new analysis shows.

An observational study found in a cohort of more than 22,000 patients, with a mean age of 66.1, chronic NSAID use was associated with a 47% increased risk of cardiovascular events compared to non-users.  The trial was conducted with data from the hypertension trial INVEST, a trial comparing treatment with and without a calcium channel blocker in patients with hypertension and coronary artery disease.

Researchers asked each patient about their use if NSAIDs at every follow-up visit and patients who reported NSAID use at every visit were identified as chronic users, while all others were identified as non-chronic users.  After a mean follow-up of 2.7 years the researchers compared the 882 chronic NSAID users with the 14,408 non-users.

The primary outcome of all-cause death, non-fatal myocardial infarction or non-fatal stroke occurred at a rate of 4.4 events per 100 patient-years in chronic NSAID users and 3.7 events per 100 patient-years in non-chronic NSAID users, a 47% increased relative risk due largely to a 2.3-fold increase in the risk of cardiovascular mortality.  Lead author Dr Anthony Bavry, a cardiologist at the University of Florida, concluded: ‘Among hypertensive patients with coronary artery disease, chronic self-reported use of NSAIDs was associated with an increased risk of adverse events during long-term follow-up.'

Dr Barry said: ‘We found a significant increase in adverse cardiovascular outcomes, primarily driven by an increase in cardiovascular mortality. This is not the first study to show there is potential harm with these agents, but I think it further solidifies that concern.  ‘When I see patients like these… I try to get them to switch to an alternative agent, such as paracetamol, or if that's not possible I at least try to get them to reduce the dose of NSAID or the frequency of dosing. But ultimately it's up to them if this potential risk is worth taking.'

Am J Med. 2011 Jul;124(7):614-20.