Cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs and the risk of ischemic stroke - A nested case-control study
Cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs and the risk of ischemic stroke - A nested case-control study
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DOI：
10.1161/01.str.0000226642.55207.94
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发表时间：
2006-07-01
期刊：
影响因子：
8.3
通讯作者：
Garbe, Edeltraut
中科院分区：
文献类型：
--
作者：
Andersohn, Frank;Schade, Rene;Garbe, Edeltraut
背景和目的——多项随机试验和大量流行病学研究提供的证据表明，急性心肌梗死的风险增加与使用环氧合酶（COX）-2选择性非甾体抗炎药（NSAID）相关。关于与 COX-2 抑制剂相关的缺血性中风风险的数据很少。 方法 - 我们对英国全科医学研究数据库 (GPRD) 中登记的 469 674 名患者进行了一项巢式病例对照研究，这些患者在 2000 年 6 月 1 日至 2004 年 10 月 31 日期间至少服用过 1 次 NSAID 处方。总共确定了 3094 例缺血性中风病例，其中 11 859 名患者患有缺血性中风。对照组按年龄进行匹配。性别、进入队列的年份和一般实践。通过条件逻辑回归计算与使用 COX-2 选择性 NSAID 相关的缺血性卒中的比值比 (OR)。 结果 - 目前使用罗非昔布（OR = 1.71；95% CI，1.33 至 2.18）、依托考昔（OR = 2.38：95% CI，1.10 至 5.13），但不包括塞来昔布（OR = 1.07；95% CI，0.79 至 1.44）与缺血性中风风险显着增加相关。对于罗非考昔和依托考昔，OR 往往会随着每日剂量的增加和使用时间的延长而增加，并且在没有主要卒中危险因素的患者中也会升高。结论 - 我们的研究表明，COX-2 选择性 NSAID 引起缺血性脑血管事件的可能性不同。个别 COX-2 抑制剂的其他药理学特性可能会影响缺血性中风的风险增加。
Background and Purpose-Several randomized trials and a large number of epidemiological studies have provided evidence of an increased risk of acute myocardial infarction associated with the use of cyclooxygenase (COX)-2 selective nonsteroidal anti-inflammatory drugs (NSAIDs). Few data are available concerning the risk of ischemic stroke associated with COX-2 inhibitors.Methods-We performed a nested case-control study in a cohort of 469 674 patients registered within the UK General Practice Research Database (GPRD), who had at least 1 prescription of an NSAID between June 1, 2000 and October 31, 2004. A total of 3094 cases with ischemic stroke were identified and 11 859 controls were matched on age. sex, year of cohort entry and general practice. Odds ratios (ORs) of ischemic stroke associated with the use of COX-2 selective NSAIDs were calculated by conditional logistic regression.Results-Current use of rofecoxib (OR = 1.71; 95% CI, 1.33 to 2.18), etoricoxib (OR = 2.38: 95% CI, 1.10 to 5.13), but not of celecoxib (OR = 1.07; 95% CI, 0.79 to 1.44) was associated with a significantly increased risk of ischemic stroke. For rofecoxib and etoricoxib, ORs tended to increase with higher daily dose and longer duration of use and were also elevated in patients without major stroke risk factors.Conclusions-Our study suggests that COX-2 selective NSAIDs differ in their potential to cause ischemic cerebrovascular events. An increased risk of ischemic stroke may be influenced by additional pharmacological properties of individual COX-2 inhibitors.