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The Risk of Acute Myocardial Infarction with Etodolac Is not Increased Compared to Naproxen: A Historical Cohort Analysis of a Generic COX-2 Selective Inhibitor

Division of Cardiology, University of Texas Southwestern Medical School, Dallas, Texas, john.warner{at}utsouthwestern.edu

Rick A. Weideman, PharmD

Division of Pharmacy, Dallas Veterans Affairs Medical Center, Dallas, Texas

Kevin C. Kelly, PharmD

Division of Pharmacy, Dallas Veterans Affairs Medical Center, Dallas, Texas

Emmanouil S. Brilakis, MD

Division of Cardiology, University of Texas Southwestern Medical School, Dallas, Texas, Department of Medicine, Dallas Veterans Affairs Medical Center, Dallas, Texas

Subhash Banerjee, MD

Division of Cardiology, University of Texas Southwestern Medical School, Dallas, Texas, Department of Medicine, Dallas Veterans Affairs Medical Center, Dallas, Texas

Francesca Cunningham, PharmD

Department of Veterans Affairs, Pharmacy Benefits Management Services, Hines, Illinois

William V. Harford, MD

Division of Gastroenterology, University of Texas Southwestern Medical School, Dallas, Texas, Department of Medicine, Dallas Veterans Affairs Medical Center, Dallas, Texas

Salahuddin Kazi, MD

Division of Rheumatology, University of Texas Southwestern Medical School, Dallas, Texas, Department of Medicine, Dallas Veterans Affairs Medical Center, Dallas, Texas

Bertis B. Little, PhD

Department of Medicine, Dallas Veterans Affairs Medical Center, Dallas, Texas, Texas Data Mining Research Institute and Department of Math, Physics and Engineering, Tarleton State University, Stephenville, Texas

Byron Cryer, MD

Division of Gastroenterology, University of Texas Southwestern Medical School, Dallas, Texas, Department of Medicine, Dallas Veterans Affairs Medical Center, Dallas, Texas

Background: This study compares the risk of acute myocardial infarction among patients exposed to etodolac, naproxen, celecoxib, and rofecoxib.

Methods: A retrospective cohort study in 38 258 veteran patients (26 376 patient-years) measured the adjusted odds ratios of acute myocardial infarction during exposure to etodolac, naproxen, celecoxib, or rofecoxib.

Results: Diagnosis of acute myocardial infarction was confirmed in 100 patients who were exposed to a study nonsteroidal anti-inflammatory drug. Compared to naproxen, the increased risk of acute myocardial infarction was not significant for etodolac (OR = 1.32, P = .27), whereas celecoxib (OR = 2.18, 95% CI 1.09-4.35, P = .03) and rofecoxib (OR = 2.16, 95 CI 1.04-4.46, P = .04) were significant. A post hoc analysis indicates that patients with a prior history of acute myocardial infarction had a significant, 4.26-fold risk for another acute myocardial infarction if taking celecoxib or rofecoxib.

Conclusion: Etodolac is not associated with a statistically increased risk of acute myocardial infarction compared to naproxen.

Key Words: COX-2 • celecoxib • rofecoxib • etodolac • naproxen • AMI • cohort • epidemiology

This version was published on December 1, 2008

Journal of Cardiovascular Pharmacology and Therapeutics, Vol. 13, No. 4, 252-260 (2008)
DOI: 10.1177/1074248408323136


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