study reported in BMJ finding a relationship between current NSAID use and development of atrial fibrilliation (see doi:10.1136/bmjopen-2013-004059). they looked at a group within the ongoing Rotterdam Study, a prospective community-based study of elderly. 8423 people without afib at start (mean age 68.5, 58% women), followed 12.9 yrs and matched the dx of afib (either by sx or by ekg routinely done at each followup exam) with the pharmacy records (i’m not sure if nsaids are available there OTC and not recorded in database…). adjusted for risk factors of bmi, lipids, bp, diabetes, hx MI, age, sex, smoking chf. results:
–857 pts developed afib
–current users of nsaids for 15-30 days had 76% increase in risk of afib [HR 1.76 (1.07-2.88)]
–use within 30 days of discontinuation of nsaids also with HR 1.84 (1.34-2.51)
–since afib is assoc with echocardiographic inc left ventric end-syst and end-diast volumes, they also looked at those who had echos, finding 17% increase in afib in that group; but after controlling for that, still increased risk
so, a few points:
–this is observational study, so can’t prove nsaids cause afib (?? if reason people on nsaids is same thing causing afib — eg, there are some data that afib assoc with chronic inflammation)
–the echo component of this study is interesting but not so helpful: we do not have data of the echo when the patients were on nsaid and prior to developing afib
–but, (to my mind) nsaids are really overused. some by our prescribing. some by their being available OTC. but these are pretty dangerous drugs, assoc with signif GI toxicity (with some data that even worse if H Pylori co-infection), hypertension, CHF, stroke (? related to salt/fluid retention) and, renal insufficiency. and lots of less common major adverse effects (myelopathy, anaphylaxis, stevens-johnson…..). i personally discourage people from using them unless really necessary (better often to either tolerate a little pain or try acetaminophen, also not benign…). since they are OTC, i think patients often feel they must be safe.
geoff