Methods Using data from hospital discharge registries in the counties of North Jutland, Viborg, and Aarhus, Denmark,
and the Danish Civil Registration System, we identified 10 280 cases of first-time hospitalization for
MI and 102 797 sex- and age-matched non-MI population controls. All prescriptions for non-aspirin
NSAIDs filled before the date of admission for MI were identified using population-based prescription databases.
Relative risk estimates for MI were adjusted for a history of cardiovascular disease, hypertension, diabetes
mellitus, chronic bronchitis or emphysema, alcoholism, liver cirrhosis, upper gastrointestinal bleeding,
rheumatoid arthritis, systemic lupus erythematosus and the use of high-dose aspirin, platelet inhibitors,
insulin or oral hypoglycemic drugs, antihypertensive drugs, lipid-lowering drugs, oral anticoagulants, nitrates,
penicillamine, gold, oral glucocorticocoids, and hormone therapy before the date of admission for MI.
Results Current users of rofecoxib had an elevated risk estimate for hospitalization for MI compared with nonusers
of any category of non-aspirin NSAIDs (adjusted relative risk [ARR], 1.80; 95% confidence interval [CI],
1.47-2.21). Increased risk estimates were also found among current users of celecoxib (ARR, 1.25; 95%
CI, 0.97-1.62), other cyclooxygenase-2 selective inhibitors (ARR, 1.45; 95% CI, 1.09-1.93), naproxen (ARR, 1.50; 95% CI,
0.99-2.29), and other conventional non-aspirin NSAIDs (ARR, 1.68; 95% CI, 1.52-1.85). The highest ARRs were found among new users of all examined drug categories.
Conclusions Current and new users of all classes of non-aspirin NSAIDs had
elevated relative risk estimates for MI. Although the increased risk estimates may partly reflect unmeasured
bias, they indicate the need for further examination of the cardiovascular safety of all non-aspirin
Author Affiliations: Department of Clinical Epidemiology, Aarhus Hospital, Aarhus University Hospital, Aarhus, Denmark
(Drs Johnsen, Nørgård, and Sørensen and Ms Larsson); Center of Cardiovascular Research, Aalborg Hospital, Aarhus University
Hospital, Aalborg, Denmark (Dr Johnsen); International Epidemiology Institute, Rockville, Md (Drs Tarone and McLaughlin);
Department of Medicine, Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, Tenn (Drs Tarone
and McLaughlin); and Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark (Dr Friis).