NSAIDs, COX-2 Inhibitors Tied to Increased Risk of A-Fib

Association strongest for new users, with a higher risk for COX-2 inhibitors than NSAIDs

THURSDAY, July 7 (HealthDay News) -- Use of non-aspirin, non-selective non-steroidal anti-inflammatory drugs (NSAIDs) or selective cyclooxygenase (COX) 2 inhibitors is associated with an increased risk of atrial fibrillation or flutter, according to a study published online July 4 in BMJ.

Morten Schmidt, from the Aarhus University Hospital in Denmark, and colleagues assessed the risk of atrial fibrillation or flutter correlated with the use of NSAIDs or COX 2 inhibitors. Between 1999 and 2008, 32,602 patients who had a first diagnosis of atrial fibrillation or flutter, were compared with 325,918 age- and gender-matched controls. Primary outcomes were current or recent use of NSAID at the time of admission, with current use categorized as new (first prescription within 60 days before diagnosis) or long-term use.

The investigators found that non-selective NSAIDs or COX 2 inhibitors were currently used by 9 percent of patients and 7 percent of controls. The incidence rate ratio (IRR) linking current use with atrial fibrillation or flutter was 1.33 for non-selective NSAIDs and 1.50 for COX 2 inhibitors, compared with no use, which reduced to 1.17 and 1.27, respectively, after adjusting for age, gender, and risk factors. The adjusted IRR in new users was 1.46 for non-selective NSAIDs and 1.71 for COX 2 inhibitors. Similar results were seen for individual NSAIDs.

"Use of non-aspirin NSAIDs was associated with an increased risk of atrial fibrillation or flutter. Compared with non-users, the association was strongest for new users, with a 40 to 70 percent increase in relative risk (lowest for non-selective NSAIDs and highest for COX 2 inhibitors)," the authors write.

One of the study authors disclosed financial ties with a pharmaceutical company.

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