Background: Use of non-steroidal anti-inflammatory drugs (NSAIDs) is general considered contraindicated in the presence of cardiac disease, except for acute pericarditis. Data to support their safety in use for acute pericarditis are lacking.
Objectives: To evaluate the cardiovascular safety of ibuprofen use for acute pericarditis.
Methods: We conducted a nationwide, population-based cohort study of all individuals receiving a first-time hospital diagnosis for acute pericarditis during 1996–2020 without prevalent NSAID use (n=18,192). We followed these patients from discharge until an outcome (myocardial infarction, ischemic stroke, congestive heart failure, or all-cause death), emigration, or December 31st, 2020, whichever occurred first. We assessed ibuprofen use in a time-varying manner, considering an individual exposed from the time of a filled prescription until the end of an exposure period, estimated from average use of 1200 mg per day. We calculated incidence rates and used a Cox regression to calculate hazard ratios (HRs) of the association between ibuprofen use and the outcomes.
Results: During 147,612 years at risk, we observed 6,092 cardiovascular events, resulting in an incidence rate per 1000 person-years of 41.3 (95% confidence interval [CI]: 40.2–42.3). The patients filled prescriptions for ibuprofen doses raging between 400 mg and 800 mg and they were on average considered exposed 33 days after a filled prescription. The HRs comparing NSAID use with no use were 0.89 (95% CI: 0.70–1.12) for the composite outcome, 1.07 (95% CI: 0.61–1.88) for myocardial infarction, 1.10 (95% CI: 0.64–1.91) for ischemic stroke, 0.92 (95% CI: 0.59–1.44) for heart failure, and 1.00 (95% CI: 0.78–1.30) for all-cause death.
Conclusions: Use of ibuprofen after first-time acute pericarditis was not associated with increased cardiovascular risk. Our results indicate that ibuprofen is a safe treatment for acute pericarditis and thus support current clinical practice.
