Although NSAID use among patients with CAD has decreased and is lower than among patients without CAD, it remains relatively high in those with severe CAD.
Key Findings
Results
NSAID use declined over the study period regardless of CAD severity in patients undergoing CCTA or ICA.
Decline was statistically significant with p < 0.001 for both CCTA and ICA cohorts
The study covered 2008–2022 for CCTA (n = 91,230) and ICA (n = 128,327), and 2016–2022 for MPI (n = 17,044)
The study used population-based healthcare data from Western Denmark, covering 3.3 million inhabitants
One-year prevalence proportion of NSAID use after diagnostic procedures was calculated and stratified by procedure-defined CAD severity
Results
In 2021, patients with severe CAD diagnosed using CCTA had lower NSAID use than those without CAD, but use remained notable.
One-year prevalence of NSAID use was 17% among patients with severe CAD vs. 24% among patients without CAD diagnosed using CCTA
Prevalence proportion ratio (PPR) was 0.73 (95% CI: 0.60–0.90)
CCTA cohort included 91,230 patients assessed from 2008 to 2022
Results
Among patients undergoing MPI, those with severe CAD used NSAIDs less frequently than those with no CAD.
9% of patients with severe CAD vs. 15% of those with no CAD used NSAIDs in the MPI cohort
PPR was 0.58 (95% CI: 0.45–0.73)
MPI cohort included 17,044 patients assessed from 2016 to 2022
Results
Among patients undergoing invasive coronary angiography (ICA), NSAID use was substantially lower in those with severe CAD compared to those with no CAD.
10% of patients with severe CAD vs. 20% of those with no CAD used NSAIDs in the ICA cohort
PPR was 0.53 (95% CI: 0.44–0.62)
ICA cohort included 128,327 patients assessed from 2008 to 2022
This represented the largest absolute difference in NSAID use between severe and no-CAD groups across all three cohorts
Results
NSAID use was inversely associated with CAD severity across all three diagnostic cohorts.
Patients without CAD consistently had higher NSAID prevalence than those with severe CAD across CCTA, MPI, and ICA cohorts
PPRs ranged from 0.53 to 0.73 comparing severe CAD to no CAD groups
Three cohorts were categorised based on first-time diagnostic procedure for CAD assessment
Despite lower use in severe CAD, NSAID use was described as 'relatively high' in this group
What This Means
This research suggests that among patients evaluated for coronary artery disease (CAD) in Western Denmark between 2008 and 2022, the use of non-steroidal anti-inflammatory drugs (NSAIDs)—common pain relievers like ibuprofen—has been declining over time. The study followed over 236,000 patients who underwent one of three types of heart diagnostic tests and tracked how many used NSAIDs in the year following their diagnosis. Overall, patients found to have more severe heart disease were less likely to use NSAIDs compared to those with no CAD detected, likely reflecting greater awareness among clinicians and patients about the cardiovascular risks associated with these medications.
Despite this encouraging trend, the study found that a meaningful proportion of patients with severe CAD—ranging from 9% to 17% depending on the type of diagnostic test—still used NSAIDs in the year after their evaluation. This is notable because NSAIDs are generally considered potentially harmful for people with established heart disease, as they can raise blood pressure and increase the risk of cardiovascular events. The gap in NSAID use between those with severe CAD and those with no CAD, while present, suggests that prescribing practices or patient self-medication may not fully reflect the degree of cardiovascular risk.
This research suggests that efforts to reduce NSAID use in high-risk cardiac patients have had some effect, but that a substantial number of patients with serious coronary artery disease continue to use these medications. The findings highlight a potential gap in clinical practice and patient education regarding the risks of NSAID use in people with significant heart disease, and may point to a need for continued attention to pain management alternatives in this population.
Bech-Drewes A, Bonnesen K, Böttcher M, Søby J, Winther S, Pedersen L, et al.. (2026). Non-steroidal anti-inflammatory drug use in patients with varying severity of coronary artery disease.. European journal of clinical pharmacology. https://doi.org/10.1007/s00228-026-04132-5