Non-steroidal anti-inflammatory drugs and incident atrial fibrillation

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used drugs, but much attention has been focused on the relationship of these drugs to cardiovascular conditions.1 In this issue of European Heart Journal – Cardiovascular Pharmacotherapy, Olsen et al.2 reported on an association, which has had perhaps less attention: the higher risk of developing atrial fibrillation (AF) in patients with prior myocardial infarction (MI) taking NSAIDs. The authors reported a crude event incidence of 2.2 [95% confidence interval (CI) 2.0–2.4] per 100 person-years in post-MI patients prescribed with NSAIDs, compared with patients never prescribed. The adjusted multivariable risk analysis showed that NSAIDs were associated with a hazard ratio (HR) equal to 1.27 (95% CI 1.14–1.40). The risk of developing AF remains high regardless of NSAID type and length of treatment. Olsen et al. provide a detailed analysis of confounding factors, demonstrating that co-morbidities like rheumatic disease, possibly influencing the NSAID prescription, did not affect AF onset and risk.