Increased cardiovascular risk for diclofenac initiators

(HealthDay)—Diclofenac initiators have increased cardiovascular risk compared with non-initiators, according to a study published online Sept. 4 in The BMJ.

Morten Schmidt, M.D., Ph.D., from Aarhus University Hospital in Denmark, and colleagues examined the cardiovascular risks of diclofenac initiation versus initiation of other non-steroidal anti-inflammatory drugs, initiation of acetaminophen, and no initiation using data from a series of 252 nationwide cohort studies. Data were included for 1,370,832 diclofenac initiators, 3,878,454 ibuprofen initiators, 291,490 naproxen initiators, 764,781 health care-seeking acetaminophen initiators matched by propensity score, and 1,303,209 propensity score-matched health care-seeking non-initiators.

The researchers found that the adverse event rate was increased among diclofenac initiators versus non-initiators (incidence rate ratio [IRR], 1.5), acetaminophen or ibuprofen initiators (IRR, 1.2), and naproxen initiators (IRR, 1.3). The event rate for diclofenac initiators was increased for each component of the combined end point (IRRs, 1.2, 1.6, 1.7, 1.9, and 1.7 for atrial fibrillation/flutter, ischemic stroke, heart failure, myocardial infarction, and cardiac death, respectively); increases were also seen for low doses of diclofenac compared with non-initiators. The relative risk of major adverse cardiovascular events was highest in individuals with low or moderate baseline risk, while the highest absolute risk was seen for individuals with high baseline risk.

"Diclofenac poses a cardiovascular health risk compared with non-use, [acetaminophen] use, and use of other traditional non-steroidal anti-inflammatory drugs," the authors write.

The study was partially funded by the Novo Nordisk Foundation.