Influence of cholesterol levels on NSAID-associated cardiovascular risks
after myocardial infarction: a population-based cohort study
Abstract
Purpose To examine whether low-density lipoprotein cholesterol
(LDL-C) levels influence the cardiovascular risk associated with
non-aspirin non-steroidal anti-inflammatory drug (NSAID) use after
myocardial infarction (MI). Methods Using Danish health
registries, we conducted a population-based cohort study of all adult
patients with first-time MI during 2010–2020 with an LDL-C value before
discharge. Based on the latest LDL-C value, we categorized patients into
a low and a high LDL-C group (<3.0 vs. ≥3.0 mmol/L). We
used time varying Cox regression to compute hazard ratios (HRs) with
95% confidence intervals of the association between NSAID use and a
major adverse cardiovascular event (MACE: recurrent MI, ischemic stroke,
and all-cause death). Results We followed 50,573 patients for a
median of 3.1 years. While exposed, 521 patients experienced a MACE: 312
in the low LDL-C group and 209 in the high LDL-C group. The HRs for MACE
comparing NSAID use with non-use were 1.21 (1.11–1.32) overall, 1.19
(1.06–1.33) in the low LDL-C group, and 1.23 (1.07–1.41) in the high
LDL-group. The HRs for recurrent MI and ischemic stroke were comparable
between the LDL-C subgroups. The HRs for all-cause death were 1.22
(1.07–1.39) in the low LDL-C group and 1.54 (1.30–1.83) in the high
LDL-C group. Changing the cut-off value for LDL-C to 1.8 and 1.4 mmol/L
showed consistent results. Conclusion In patients with MI,
LDL-C levels did not influence the increased risk of MACE associated
with NSAID use, but might influence the association between NSAID use
and all-cause death.