Use of nicotine replacement therapy and the risk of acute myocardial infarction, stroke, and death
Use of nicotine replacement therapy and the risk of acute myocardial infarction, stroke, and death
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DOI：
10.1136/tc.2005.011387
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发表时间：
2005-12-01
期刊：
影响因子：
5.2
通讯作者：
Britton, J
中科院分区：
文献类型：
--
作者：
Hubbard, R;Lewis, S;Britton, J
目的：确定尼古丁替代疗法(NRT)是否与急性心肌梗死、急性中风或死亡的风险增加有关。设计：对健康改善网络(Thin)的数据进行自身对照病例系列分析，以估计在NRT第一次处方前后4个14天期间心肌梗死和中风的相对发生率。背景：Thin是一个计算机化的全科医学数据库。研究对象：对THIN有贡献的患者。干预：NRT的观察性研究。主要结果：急性心肌梗死、急性中风和死亡。结果：33 247人服用NRT，其中861人有心肌梗死，506人有中风。首次心肌梗死的发生率在首次NRT处方开始前的56d内呈进行性增加(总发生率比5.55，95%可信区间(CI)4.42~6.98)，但此后发病率下降，开始NRT后56d的发病率没有增加(发生率比1.27，95%CI 0.82~1.97)。对于二次心肌梗死和中风，以及既往有心绞痛和高血压的亚组，结果是相似的。在我们的队列中，在开始NRT后的平均2.6年的随访期中有960人死亡，在NRT处方后的56天内没有证据表明死亡率增加(发生率比0.86，95%CI 0.60到1.23)。结论：NRT的使用与心肌梗死、中风或死亡的风险增加无关。
Objective: To determine whether nicotine replacement therapy (NRT) is associated with an increased risk of acute myocardial infarction, acute stroke, or death.Design: Self control case series analysis of data from The Health Improvement Network (THIN) to estimate the relative incidence of myocardial infarction and stroke in four 14 day periods before and after the first prescription for NRT.Setting: THIN is a computerised general practice database.Subjects: Patients contributing data to THIN.Interventions: Observational study of NRT.Main outcomes: Acute myocardial infarction, acute stroke, and death.Results: 33 247 individuals had been prescribed NRT, of whom 861 had had a myocardial infarction and 506 a stroke. There was a progressive increase in the incidence of first myocardial infarction in the 56 days leading up to the first NRT prescription (overall incidence ratio 5.55, 95% confidence interval (Cl) 4.42 to 6.98), but the incidence fell after this time and was not increased in the 56 days after starting NRT (incidence ratio 1.27, 95% Cl 0.82 to 1.97). The results were similar for second myocardial infarction and stroke, and for subgroups of people with pre-existing angina and hypertension. There were 960 deaths in our cohort during a mean follow up period of 2.6 years after starting NRT, with no evidence of an increased mortality in the 56 days after the NRT prescription (incidence ratio 0.86, 95% Cl 0.60 to 1.23).Conclusions: The use of NRT is not associated with any increase in the risk of myocardial infarction, stroke, or death.