ORLANDO — Diclofenac, celecoxib, and rofecoxib are associated with dose-dependent increased risks of sudden cardiac arrest, according to a large national Danish study.
No increased risk was noted in conjunction with the use of ibuprofen or naproxen, Dr. Frederik Folke reported at the annual meeting of the American College of Cardiology.
He presented a case-crossover study involving 12,288 Danes who experienced out-of-hospital sudden cardiac arrest in 2001-2004. They were included in the unique Danish Cardiac Arrest Registry, which incorporates all cases of out-of-hospital cardiac arrest occurring in the country. Their prior use of all NSAIDs was identified through linkage to nationwide pharmacy drug-dispensing records.
In all, 40% of patients used an NSAID within 30 days prior to their cardiac arrest. The most widely used NSAIDs were ibuprofen (Advil, Motrin), used by 44.5%; diclofenac (Voltaren), used by 23%, the selective cyclooxygenase-2 inhibitors celecoxib (Celebrex) and rofecoxib (Vioxx), used by 13.9% each; and naproxen (Aleve), used by 4.7% of patients within 30 days of their cardiac arrest.
Under the study's case-crossover design, patients' use or nonuse of NSAIDs within 30 days prior to cardiac arrest was compared with their use or nonuse during two control periods: 60-90 and 90-120 days prior to their cardiac event. This design, in which patients serve as their own controls, eliminates the effects of many potential confounders, explained Dr. Folke, a cardiologist at Gentofte (Denmark) Hospital.
Use of diclofenac, celecoxib, or rofecoxib within 30 days was associated with increased risks of sudden cardiac arrest ranging in dose-dependent fashion from about 1.5-fold to 2.5-fold.
Although rofecoxib has been withdrawn from the market, celecoxib and diclofenac remain widely prescribed. Diclofenac is OTC in some countries, exposing people to increased risk of cardiac arrest by their taking diclofenac without medical supervision or an informed consideration of the risks vs. benefits, he said.
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