NSAID Use Associated With Risk of Atrial Fibrillation or Flutter

NSAIDs and AF

Michael O'Riordan

July 5, 2011 (Aarhus, Denmark) — Nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) and selective COX-2 inhibitors are associated with an increased risk of atrial fibrillation or flutter, according to the results of a new population-based, case-control study [1]. The study adds evidence that these arrhythmic risks should be added to the overall CV risks when considering prescribing NSAIDs, say researchers.

"It's important to know that the absolute risk of atrial fibrillation associated with these drugs is still low," lead investigator Morten Schmidt (Aarhus University Hospital, Denmark) told heartwire . "The use of NSAIDs is associated with an increased risk, but overall the absolute risk is still small. Like any other drug, for physicians that prescribe NSAIDs it continues to be a question of balancing the benefits and risks."/.../

Even Short-Term NSAID Use Risky in Cardiac Patients

Megan Brooks

Authors and Disclosures

May 9, 2011 — In patients with prior myocardial infarction (MI), most nonsteroidal anti-inflammatory drugs (NSAIDs), even when taken for as little as 1 week, are associated with an increased risk for death and recurrent MI, new observational data indicate.

Use of NSAIDs was associated with a 45% increased risk for death or recurrent MI in the first 7 days of treatment and a 55% increased risk if treatment continued to 3 months. The findings were published online May 9 in Circulation/.../.

Aspirin for Primary Prevention

Aspirin for Primary Prevention of Cardiovascular Events in Diabetes

Still an Open Question

Antonio Nicolucci, MD 

JAMA. 2008;300(18):(doi:10.1001/jama.2008.625).

The use of aspirin for primary prevention of cardiovascular events in individuals with diabetes is widely recommended byexisting guidelines, but the evidence supporting its efficacy is surprisingly scarce.¹ Recommendations seem based mainly onextrapolations from data from other high-risk groups, rather than on solid data derived from studies conducted specifically in patients with diabetes. Indeed, an increasing amount of evidence suggests that the efficacy of antiplatelet therapy in patients with diabetes may be lower than in individuals without diabetes.²

ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use

Deepak L. Bhatt, MD, FACC, FAHA, et al

This document has been developed by the American College of Cardiology Foundation (ACCF) Task Force on Clinical Expert Consensus Documents, the American College of Gastroenterology (ACG), and the American Heart Association (AHA). Expert consensus documents (ECDs) are intended to inform practitioners, payers, and other interested parties of the opinion of the ACCF and document cosponsors concerning evolving areas of clinical practice and/or technologies that are widely available or new to the practice community. Topics chosen for coverage by ECDs are so designed because theevidence base, the experience with technology, and/or the clinical practice are not considered sufficiently well developed to beevaluated by the formal American College of Cardiology/American Heart Association (ACC/AHA) practice guidelines process. Often the topic is the subject of ongoing investigation. Thus, the reader should view ECDs as the best attempt of the ACCF and other cosponsors to inform and guide clinical practice in areas where rigorous evidence may not be available or the evidence to date is not widely accepted. When feasible, ECDs includeindications or contraindications. Topics covered by ECDs may be addressed subsequently by the ACC/AHA Practice Guidelines Committee as new evidence evolves and is evaluated.

The Task Force on ECDs makes every effort to avoid any actual or potential conflicts of interest that might arise as a result of an outside relationship or personal interest of a member of the writing panel. Specifically, all members of the writing panel are asked to provide disclosure statements of all such relationships that might be perceived as real or potential conflicts of interest to inform the writing effort. These statements are reviewed by the parent task force, reported orally to all members of the writing panel at the first meeting, and updated as changes occur. The relationships with industry information for writing committee members and peer reviewers are listed in Appendixes 1 and 2, respectively./.../

ezetimibe/simvastatin versus simvastatin versus atorvastatin

1: Am J Cardiol. 2007 Jun 15;99(12):1706-1713. Epub 2007 May 2. Related Articles, Links


Comparison of effects of ezetimibe/simvastatin versus simvastatin versus atorvastatin in reducing C-reactive protein and low-density lipoprotein cholesterol levels.

Pearson T, Ballantyne C, Sisk C, Shah A, Veltri E, Maccubbin D.

University of Rochester School of Medicine and Dentistry, Rochester, New York.
The lowering effects of ezetimibe/simvastatin combination therapy on low-density lipoprotein (LDL) cholesterol and high-sensitivity C-reactive protein (CRP) were compared with those of simvastatin or atorvastatin monotherapy in a large cohort of patients with primary hypercholesterolemia. To compare ezetimibe/simvastatin with simvastatin, data were combined from 3 identical, prospective 12-week trials in which patients were randomized to receive placebo; ezetimibe 10 mg; ezetimibe 10 mg added to simvastatin 10, 20, 40, or 80 mg; or simvastatin 10, 20, 40, or 80 mg. To compare ezetimibe/simvastatin with atorvastatin, data were analyzed from a phase III double-blind, active-controlled study in which patients were randomized equally to receive ezetimibe/simvastatin 10/10, 10/20, 10/40, or 10/80 mg or atorvastatin 10, 20, 40, or 80 mg for 6 weeks. When averaged across doses, ezetimibe/simvastatin produced significantly greater reductions compared with simvastatin alone in LDL cholesterol (52.5% vs 38.0%, respectively) and CRP levels (31.0% vs 14.3%, respectively). At each individual simvastatin dose, co-administration with ezetimibe produced significant further CRP reductions versus simvastatin alone. Ezetimibe/simvastatin was significantly more effective at lowering LDL cholesterol than atorvastatin when pooled across doses (53.4% vs 45.3%, respectively) and in each milligram-equivalent dose comparison. Reductions in CRP of similar magnitude were observed with ezetimibe/simvastatin and atorvastatin when averaged across doses and at each milligram-equivalent statin dose comparison. In conclusion, the lipid-modulating and anti-inflammatory effects of ezetimibe/simvastatin provide additional benefits not realized by statin monotherapy alone.

PMID: 17560879 [PubMed - in process]