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Influence of Low-Density Lipoprotein Cholesterol Levels on NSAID-Associated Cardiovascular Risks After Myocardial

Mohab Basem1, Kasper Bonnesen1, Lars Pedersen1

  • 1Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.

Clinical Epidemiology
|April 29, 2024
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Summary

Non-aspirin NSAID use increases cardiovascular risk after myocardial infarction (MI). Low-density lipoprotein cholesterol (LDL-C) levels did not alter this risk for major adverse cardiovascular events (MACE), but may affect all-cause death risk.

Keywords:
cardiovascular diseasecholesteroleffect modificationlow-density lipoprotein cholesterolmyocardial infarctionnon-steroidal anti-inflammatory drugs

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Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Epidemiology

Background:

  • Non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used.
  • NSAID use after myocardial infarction (MI) is associated with increased cardiovascular risk.
  • The role of low-density lipoprotein cholesterol (LDL-C) in modulating this risk is unclear.

Purpose of the Study:

  • To investigate if LDL-C levels modify the cardiovascular risk associated with non-aspirin NSAID use in patients post-MI.
  • To assess the impact of NSAID use on major adverse cardiovascular events (MACE) stratified by LDL-C levels.

Main Methods:

  • Population-based cohort study using Danish health registries (2010-2020).
  • Included adult patients with first-time MI and pre-discharge LDL-C values.
  • Categorized patients into low (<3.0 mmol/L) and high (≥3.0 mmol/L) LDL-C groups.
  • Time-varying Cox regression used to calculate hazard ratios (HRs) for MACE (recurrent MI, ischemic stroke, all-cause death).

Main Results:

  • Followed 50,573 patients for a median of 3.1 years; 521 experienced MACE.
  • Overall HR for MACE with NSAID use was 1.21 (1.11-1.32).
  • HRs for MACE were similar in low (1.19) and high (1.23) LDL-C groups.
  • NSAID use was associated with higher all-cause death HR in high LDL-C group (1.54) compared to low LDL-C group (1.22).

Conclusions:

  • LDL-C levels did not influence the increased risk of MACE associated with NSAID use post-MI.
  • A potential influence of LDL-C levels on the association between NSAID use and all-cause death was observed.
  • Findings suggest careful consideration of NSAID use in MI patients, particularly those with high LDL-C.