Caught Between A Rock And A Hard Place - Part 3

Back in March, I wrote about a study linking non-steroidal anti-inflammatory drugs (NSAIDs) to erectile dysfunction.  Just last week, a new case-control study linked NSAIDs to atrial fibrillation & atrial flutter.  Why is this such a big deal?  Atrial fibrillation increases one's risk for stroke, heart failure & death.  Oftentimes, one is sentenced to a lifetime of anticoagulation with its attendant regular & continued blood monitoring to minimize one's risk of bleeding.  So whatever we can do to prevent this condition is a good thing.

How did the authors arrive at their bad news?  They analyzed 32,602 Danes who were diagnosed with atrial fibrillation or atrial flutter and compared them to 325,918 age- and sex-matched controls.  Of this cohort, 2,925 cases and 21,871 controls were users of NSAIDs.

Regardless of whether non-selective NSAIDs or the relatively newer cyclo-oxygenase (COX) 2 inhibitors were used, the authors reported a 40-70% increase in the relative risk of atrial fibrillation or atrial flutter.  While this may sound alarming, this is, in fact, equivalent to an extra 4 cases of atrial fibrillation each year for every 1,000 new users of non-selective NSAIDs and 7 extra cases per year for every 1,000 new users of COX 2 inhibitors.

Granted, this type of study is good for developing hypotheses and theories but not for demonstrating proof of cause & effect.  However, before you start taking your NSAIDs, make sure you discuss the known negative outcomes with your physician, eg increase in blood pressure and decrease in kidney function, as well as the possible issues, eg erectile dysfunction, and now, atrial fibrillation or atrial flutter.  If you're already taking an NSAID, it's not a bad idea to chat w/your family physician about whether you truly need to continue taking it.