Risk of acute myocardial infarction and sudden cardiac death in patients treated with cyclo-oxygenase 2 selective and non-selective non-steroidal inflammatory drugs: Nested case-control study
Risk of acute myocardial infarction and sudden cardiac death in patients treated with cyclo-oxygenase 2 selective and non-selective non-steroidal inflammatory drugs: Nested case-control study
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DOI：
10.1016/j.jvs.2005.02.007
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发表时间：
2005-04
影响因子：
4.3
通讯作者：
D. Graham;D. Campen;R. Hui
中科院分区：
文献类型：
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作者：
D. Graham;D. Campen;R. Hui
关于大剂量罗非昔布增加或萘普生降低严重冠心病风险的问题一直存在争议。我们试图确定与远程非甾体抗炎药（NSAID）或塞来昔布相比，高剂量或标准剂量的罗非昔布是否会增加风险，因为塞来昔布是罗非昔布最常见的替代品。方法：我们使用来自加利福尼亚Kaiser Permanente的数据，对1999年1月1日至2001年12月31日期间接受非甾体抗炎药治疗的所有18-84岁患者进行队列研究，其中我们进行了巢式病例对照研究。严重冠心病（急性心肌梗死和心源性猝死）病例的风险集与年龄、性别和健康计划地区的4个对照相匹配。将当前暴露于环加氧酶2选择性和非选择性非甾体抗炎药与远程暴露于任何非甾体抗炎药进行比较，并将罗非昔布与塞来昔布进行比较。结果随访2 302 029人-年，发生严重冠心病8143例，其中死亡2210例（27.1%）。罗非昔布与塞来昔布的多因素校正优势比为：罗非昔布（所有剂量）为1.59 (95% CI 1.10 - 2.32, p= 0.015)；罗非昔布≤25 mg/天组为1.47 (0.99 ~ 2.17,p= 0.054)；罗非昔布大于25 mg/d组为3.58 （1.27 ~ 10.11,p= 0.016）。萘普生与远程使用非甾体抗炎药的校正优势比为1.14 （1.00 - 1.30,p= 0.05）。解释：与塞来昔布相比，罗非昔布的使用增加了严重冠心病的风险。使用萘普生并不能预防严重的冠心病。
BackgroundControversy has surrounded the question about whether high-dose rofecoxib increases or naproxen decreases the risk of serious coronary heart disease. We sought to establish if risk was enhanced with rofecoxib at either high or standard doses compared with remote non-steroidal anti-inflammatory drug (NSAID) use or celecoxib use, because celecoxib was the most common alternative to rofecoxib.MethodsWe used data from Kaiser Permanente in California to assemble a cohort of all patients age 18–84 years treated with a NSAID between Jan 1, 1999, and Dec 31, 2001, within which we did a nested case-control study. Cases of serious coronary heart disease (acute myocardial infarction and sudden cardiac death) were risk-set matched with four controls for age, sex, and health plan region. Current exposure to cyclo-oxygenase 2 selective and non-selective NSAIDs was compared with remote exposure to any NSAID, and rofecoxib was compared with celecoxib.FindingsDuring 2 302 029 person-years of follow-up, 8143 cases of serious coronary heart disease occurred, of which 2210 (27·1%) were fatal. Multivariate adjusted odds ratios versus celecoxib were: for rofecoxib (all doses), 1·59 (95% CI 1·10–2·32, p=0·015); for rofecoxib 25 mg/day or less, 1·47 (0·99–2·17, p=0·054); and for rofecoxib greater than 25 mg/day, 3·58 (1·27–10·11, p=0·016). For naproxen versus remote NSAID use the adjusted odds ratio was 1·14 (1·00–1·30, p=0·05).InterpretationRofecoxib use increases the risk of serious coronary heart disease compared with celecoxib use. Naproxen use does not protect against serious coronary heart disease.