Non-aspirin NSAIDs, cyclooxygenase-2 inhibitors and risk for cardiovascular events-stroke, acute myocardial infarction, and death from coronary heart disease
Non-aspirin NSAIDs, cyclooxygenase-2 inhibitors and risk for cardiovascular events-stroke, acute myocardial infarction, and death from coronary heart disease
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DOI：
10.1002/pds.1820
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发表时间：
2009-11-01
影响因子：
2.6
通讯作者：
Griffin, Marie R.
中科院分区：
文献类型：
--
作者：
Roumie, Christianne L.;Choma, Neesha N.;Griffin, Marie R.
目的确定某些非甾体抗炎药（NSAID）是否与心血管事件风险增加相关：急性心肌梗死（AMI）、中风和冠心病（CHD）死亡。方法我们对1999年1月1日至2005年12月31日期间35-94岁的田纳西州医疗补助计划登记者进行了回顾性队列研究。符合条件的受试者为非住院患者，连续入组，并且在入组队列之前没有严重疾病。研究了塞来昔布、罗非昔布、伐地昔布、布洛芬、萘普生、双氯芬酸和吲哚美辛的暴露。结果是有和没有心血管疾病（CVD）史的患者因AMI、卒中或CHD死亡而住院。调整后的风险比（aHR）和95%置信区间（95%CI）reported.Results有610001人在最后的队列和14%的基线CVD史。在无心血管疾病的患者中（N=525 249），随访人数为1566678人年，发生12 184起事件。在该组中，非使用者发生7.90起事件/1000人-年。当前使用塞来昔布的事件/1000人-年为10.41（aHR 1.00，95% CI 0.89-1.13），罗非昔布为10.91（aHR 1.21，95% CI 1.07-1.37），伐地昔布组为12.46（aHR 1.3095% CI 1.04-1.61），吲哚美辛组为13.25（aHR 1.36，95% CI 1.11-1.66）。在有CVD既往史的患者（N=84752）中，有397977人-年的随访和10248起事件。非使用者有28.30起事件/1000人-年。在CVD患者中，使用罗非昔布与事件发生率增加相关（30.28起事件/1000人-年[aHR 1.21，95% CI 1.08-1.37]），而使用那普利与事件发生率降低相关（22.66起事件/1000人-年[aHR 0.88，95% CI 0.79-0.99]）。在新用户中，结果是相似的，除了风险之间的napoleen用户不再是不同的nonusers.Conclusions，我们发现所有和新的当前用户的罗非昔布，伐地昔布，吲哚美辛的患者没有心血管疾病的历史中的心血管事件的风险增加。在CVD患者中，所有和新的当前罗非昔布使用与心血管事件的风险增加相关。版权所有（C）2009约翰威利父子有限公司
Purpose To determine if certain non-steroidal anti-inflammatory drugs (NSAIDs) are associated with increased risk of cardiovascular events: acute myocardial infarction (AMI), stroke, and death from coronary heart disease (CHD).Methods We conducted a retrospective cohort study of Tennessee Medicaid enrollees aged 35-94 years between 1 January 1999 and 31 December 2005. Eligible persons were non-institutionalized, had continuous enrollment, and had no serious illness prior to cohort entry. Exposure to celecoxib, rofecoxib, valdecoxib, ibuprofen, naproxen, diclofenac, and indomethacin was studied. The outcome was hospitalization for AMI, stroke, or death from CHD among those with and without a history of cardiovascular disease (CVD). Adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) are reported.Results There were 610001 persons in the final cohort and 14% had a baseline history of CVD. In those without CVD (N=525 249) there were 1566678 person-years of follow-up and 12 184 events. In this group, non-users had 7.90 events/1000 person-years. Events/1000 person-years were 10.41 for current use of celecoxib (aHR 1.00, 95% CI 0.89-1.13), 10.91 for rofecoxib (aHR 1.21, 95% CI 1.07-1.37), 12.46 for valdecoxib(aHR 1.3095% CI 1.04-1.61), and 13.25 for indomethacin (aHR 1.36,95% CI 1.11-1.66) compared to non-users. Among patients with a past history of CVD (N=84752) there were 397977 person-years of follow-up and 10248 events. Non-users had 28.30 events/1000 person-years. Among those with CVD, rofecoxib use was associated with increased event rate (30.28 events/1000 person-years [aHR 1.21, 95% CI 1.08-1.37]) and naproxen was associated with a decreased event rate (22.66 events/1000 person-years [aHR 0.88, 95% CI 0.79-0.99]). Among new users, the results were similar except risk among naproxen users was no longer different than non-users.Conclusions We found an increased risk of cardiovascular events among all and new current users of rofecoxib, valdecoxib, and indomethacin in patients with no history of CVD. Among patients with CVD, all and new current rofecoxib use was associated with an increased risk of a cardiovascular event. Copyright (C) 2009 John Wiley & Sons, Ltd.