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Meloxicam and risk of myocardial infarction: a population-based nested case–control study

  • Safety and Pharmacovigillance
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Abstract

Certain non-steroidal anti-inflammatory drugs (NSAIDs) have been associated with an increased risk of myocardial infarction (MI), a risk linked to cyclo-oxygenase-2 inhibition. There are limited studies assessing the risk of MI associated with meloxicam, an increasingly popular drug with COX-2 inhibiting properties. A nested matched case–control study using The Health Improvement Network, a UK population-based database was conducted. NSAID users between 35 and 89 years of age with at least 1 year enrollment in the cohort were included. Incident MI cases were matched on age, sex, practice and event date with up to 4 controls. NSAID exposure was categorized as remote (between 60 days and 1 year), recent (between 1 and 60 days) or current relative to the event date. Current users were further classified as naproxen (negative control), diclofenac (positive control), meloxicam or other NSAID users. Multivariable conditional logistic regression was conducted to determine the risk of MI for each NSAID use categories compared with that of remote users. 9291 MI cases were matched with 30,676 controls. The cases had a higher prevalence of traditional cardiac risk factors, chronic kidney disease and inflammatory arthritis and cardioprotective drug utilization. The adjusted odds ratio of MI for current user compared to remote users were: meloxicam 1.38 (1.17–1.63), naproxen 1.12 (0.96–1.30) and diclofenac 1.37 (1.25–1.50). In this large population-based study, meloxicam increased the risk of MI by 38%. This study warrants cautious use of this increasingly popular drug.

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Funding

The present study was funded by NIH AR47785.

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Authors and Affiliations

  1. Division of Rheumatology, Brown University School of Medicine, Brown University Warren Alpert School of Medicine, 375 Wampanoag Trail, Office 289, E. Providence, RI, 02915, USA

    Deepan Dalal

  2. Section of Rheumatology, Boston University Medical Centre, Boston, MA, USA

    Maureen Dubreuil & David Felson

  3. Division of Rheumatology, Boston V.A. Healthcare System, Boston, MA, USA

    Maureen Dubreuil

  4. Division of Clinical Epidemiology Research and Training, Boston University, Boston, MA, USA

    Maureen Dubreuil, Christine Peloquin, Tuhina Neogi, Yuqing Zhang & David Felson

  5. Division of Rheumatology, Massachusetts General Hospital, Boston, MA, USA

    Hyon Choi

  6. Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK

    David Felson

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  1. Deepan Dalal
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Correspondence to Deepan Dalal.

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Conflict of interest

Dr. Hyon Choi reports receiving research consultancy fee from Takeda.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Boston University Institutional Review Board and Scientific Review Committee with The Health Improvement Network database have reviewed the protocol and approved the study. De-identified publicly available data from THIN was used for purposes of the current study.

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Dalal, D., Dubreuil, M., Peloquin, C. et al. Meloxicam and risk of myocardial infarction: a population-based nested case–control study. Rheumatol Int 37, 2071–2078 (2017). https://doi.org/10.1007/s00296-017-3835-x

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