The risk for myocardial infarction with cyclooxygenase-2 inhibitors:: A population study of elderly adults
The risk for myocardial infarction with cyclooxygenase-2 inhibitors:: A population study of elderly adults
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DOI：
10.7326/0003-4819-142-7-200504050-00113
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发表时间：
2005-04-05
影响因子：
39.2
通讯作者：
Zhang, B
中科院分区：
文献类型：
--
作者：
Lévesque, LE;Brophy, JM;Zhang, B
背景：环氧化酶-2 （COX-2）选择性抑制剂自1999年以来作为非甾体抗炎药（NSAIDs）更安全的替代品上市。关于其心脏安全性的争论在最近罗非昔布的停药中达到高潮。需要进一步的研究来更好地了解这种风险，并确定这种安全问题是否代表一种等级效应。目的：评价各种非甾体抗炎药对首次心肌梗死（MI）风险的影响。设计：基于人群的回顾性队列研究，采用时间匹配的嵌套病例对照方法进行分析。环境：加拿大魁北克省。研究对象：1999年1月1日至2002年6月30日期间，113 927名无心肌梗死且新接受非甾体抗炎药治疗的老年人。测量方法：使用魁北克行政卫生数据库评估非甾体抗炎药暴露和心肌梗死的发生。结果：与事件前一年未使用非甾体抗炎药相比，目前使用罗非昔布与急性心肌梗死的风险增加相关（比率比[11111,1.24 [95% Cl， 1.05至1.46]），并且在高剂量时更为明显（RR, 1.73 [Cl， 1.09至2.76]）。同时使用阿司匹林似乎降低了与低剂量罗非昔布相关的风险（111,1.00 [CI， 0.77至1.28]），但与高剂量罗非昔布无关（111,2.36 [Cl， 1.27至4.391）。塞来昔布（1111,0.99 [Cl， 0.85至1.161]）或其他非甾体抗炎药未观察到风险增加。局限性：该研究不能完全解释所有潜在的混杂因素，包括阿司匹林和布洛芬的非处方使用。结论：这些结果提供证据表明，目前使用罗非昔布的无心肌梗死史的老年人发生急性心肌梗死的风险增加，且剂量越高，风险越大。阿司匹林的使用降低了低剂量而不是高剂量罗非昔布的风险。没有证据表明使用其他非甾体抗炎药会增加风险。
Background: Cyclooxygenase-2 (COX-2) selective inhibitors have been marketed since 1999 as safer alternatives to nonsterok dal anti-inflammatory drugs (NSAIDs). Debate about their cardiac safety has culminated in the recent withdrawal of rofecoxib. Additional studies are needed to better understand this risk and to determine whether this safety concern represents a class effect.Objective: To assess the influence of various NSAIDs on the risk for a first myocardial infarction (MI).Design: Population-based, retrospective cohort study analyzed using a time-matched, nested case-control approach.Setting: Quebec, Canada.Participants: 113 927 elderly persons without previous MI and newly treated with an NSAID between 1 January 1999 and 30 June 2002.Measurements: NSAID exposure and occurrence of MI assessed by using Quebec's administrative health databases.Results: Compared with no use of NSAIDs in the year preceding the event, current use of rofecoxib was associated with an increased risk for an acute MI (rate ratio [11111, 1.24 [95% Cl, 1.05 to 1.46]) that was more pronounced at higher doses (RR, 1.73 [Cl, 1.09 to 2.76]). The concomitant use of aspirin appears to decrease the risk associated with low-dose rofecoxib (1111, 1.00 [CI, 0.77 to 1.28]) but not with high-dose rofecoxib (1111, 2.36 [Cl, 1.27 to 4.391). No increased risks were observed with celecoxib (1111, 0.99 [Cl, 0.85 to 1.161) or the other NSAIDs.Limitations: The study could not completely account for all potential confounders, including over-the-counter use of aspirin and ibuprofen.Conclusions: These results provide evidence of an increased risk for acute MI in current users of rofecoxib among elderly persons with no history of MI. This risk appears greater at higher doses. Aspirin use mitigates the risk associated with low-dose but not high-dose rofecoxib. There was no evidence of an increased risk with the other NSAIDs.