Clinical Epidemiology (Nov 2024)
Ibuprofen for Acute Pericarditis and Associated Cardiovascular Risks: A Danish Nationwide, Population-Based Cohort Study
Abstract
Jakob Kjølby Eika,1,2,* Kasper Bonnesen,1,2,* Lars Pedersen,1,2 Vera Ehrenstein,1,2 Henrik Toft Sørensen,1,2 Morten Schmidt1– 3 1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 2Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; 3Department of Cardiology, Gødstrup Regional Hospital, Herning, Denmark*These authors contributed equally to this workCorrespondence: Morten Schmidt, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark and Department of Clinical Medicine, Aarhus University, Olof Palmes Allé 43– 45, Aarhus, 8200, Denmark, Tel +45 87 16 72 12, Email [email protected]: Ibuprofen is used to treat acute pericarditis, but high-dose ibuprofen has also been associated with increased cardiovascular risks. We examined the cardiovascular safety of using ibuprofen for acute pericarditis.Patients and Methods: A Danish nationwide, population-based cohort study including patients ≥ 18 years with first-time acute pericarditis (n=12,381) during 1996– 2020 was conducted. Ibuprofen use was modelled in two ways: First, we considered patients exposed based on the tablet strength of their first ibuprofen filling (a proxy for an intention-to-treat analysis). Second, we considered patients exposed in a time-varying manner (a proxy for an as-treated analysis). The primary outcome of major adverse cardiovascular events (MACE) was a composite of myocardial infarction, ischemic stroke, congestive heart failure, and cardiovascular death.Results: In the intention-to-treat analysis, the 1-year risk of MACE was 1.37% (95% confidence interval [CI]: 1.03– 1.79) for ibuprofen initiators and 4.32% (95% CI: 3.89– 4.78) for non-initiators. Compared with non-initiators within 1-year follow-up, the adjusted hazard ratio for MACE was 0.75 (95% CI: 0.67– 0.85) for initiators overall, 0.38 (95% CI: 0.28– 0.52) for initiators of > 400 mg tablets, and 0.87 (95% CI: 0.76– 0.99) for initiators of ≤ 400 mg tablets. In the as-treated analysis, compared with no use, the hazard ratio associated with ibuprofen use was 0.69 (95% CI: 0.54– 0.89) for MACE, 0.82 (95% CI: 0.54– 1.26) for myocardial infarction, 0.74 (95% CI: 0.45– 1.22) for ischemic stroke, 0.67 (95% CI: 0.47– 0.96) for congestive heart failure, and 0.60 (95% CI: 0.31– 1.17) for cardiovascular death.Conclusion: Ibuprofen use for acute pericarditis was not associated with increased cardiovascular risks, supporting its safety in current practice.Keywords: Pericarditis, Anti-Inflammatory Agents, non-steroidal, Cohort Study, Epidemiology
