Selective COX-2 inhibitors, NSAIDs and congestive heart failure: differences between new and recurrent cases
Selective COX-2 inhibitors, NSAIDs and congestive heart failure: differences between new and recurrent cases
复制标题
DOI：
10.1111/j.1365-2125.2008.03121.x
复制
发表时间：
2008-06-01
影响因子：
3.4
通讯作者：
Henry, David
中科院分区：
文献类型：
--
作者：
McGettigan, Patricia;Han, Pearline;Henry, David
目的量化治疗与非甾体抗炎药（NSAID）和选择性环氧合酶（考克斯）-2抑制剂和住院治疗充血性心力衰竭（CHF）之间的关系，以确定是否有风险之间的变化首次和随后的发作CHF. METHODS我们进行了一项病例对照研究之间的关系最近使用的NSAID和考克斯-2抑制剂和住院治疗CHF。病例（n = 530）为主要诊断为CHF的住院患者。对照组（n = 1054）为与病例入住同一医院的无CHF受试者。根据年龄和性别将其与病例频率匹配。结构化访谈用于获得一些研究因素的信息，包括最近使用NSAID和考克斯-2抑制剂。根据暴露比值比估计相对危险度（RR），调整一系列潜在的混杂因素。249名（23.6%）对照者在入院前一周内服用了阿司匹林、NSAID和考克斯-2抑制剂。在81/285例（28.4%）首次病例中记录了任何NSAID/考克斯-2抑制剂的使用，而在复发病例中记录了38/245例（15.5%）：差异为12.9%（95%置信区间5.9，19.8）（P = 0.0004）。调整后的RR为首次入院CHF与不同的药物暴露是：非甾体抗炎药1.1（0.67，1.83），罗非昔布1.29（0.78，2.13）和塞来昔布1.47（0.85，2.53）。结论我们发现弱和统计学上无显着关联之间的使用非甾体抗炎药和考克斯-2抑制剂和住院CHF。这种低RR与最近发表的研究结果一致，但与发现使用NSAID的风险大约加倍的早期研究不一致。与首次心衰病例相比，反复心衰病例的风险稀释和处方水平明显较低，这表明处方医生注意到NSAID可能会在脆弱个体中引发CHF的信息，并且他们将相同的信息应用于选择性考克斯-2抑制剂。
AIMSTo quantify the association between treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and selective cyclooxygenase (COX)-2 inhibitors and hospitalization due to congestive heart failure (CHF); to determine if the risk varies between first and subsequent episodes of CHF.METHODSWe conducted a case-control study of the relationship between recent use of NSAIDs and COX-2 inhibitors and hospitalization with CHF. Cases (n = 530) were patients admitted to hospital with a primary diagnosis of CHF. Controls (n = 1054) were subjects without CHF who were admitted to the same hospitals as the cases. They were frequency matched to cases on the basis of age and sex. Structured interviews were used to obtain information on a number of study factors, including recent use of NSAIDs and COX-2 inhibitors. Relative risks (RRs) were estimated from exposure odds ratios, adjusted for a range of potential confounders.RESULTSOverall, NSAIDs and COX-2 inhibitors had been taken by 249 (23.6%) controls in the week before admission to hospital. Use of any NSAID/COX-2 inhibitor was recorded in 81/285 (28.4%) first-time cases compared with 38/245 (15.5%) in recurrent cases: difference 12.9% (95% confidence interval 5.9, 19.8) (P = 0.0004). The adjusted RRs for first hospital admission for CHF with different drug exposures were: NSAIDs 1.1 (0.67, 1.83), rofecoxib 1.29 (0.78, 2.13) and celecoxib 1.47 (0.85, 2.53).CONCLUSIONSWe found weak and statistically nonsignificant associations between use of NSAIDs and COX-2 inhibitors and hospitalization with CHF. This low RR is consistent with the results of recently published studies, but not with early studies that found an approximate doubling of risk with use of NSAIDs. The dilution of risk and the significantly lower levels of prescribing for recurrent than for first-time cases of heart failure suggest that prescribing doctors heeded messages that NSAIDs may precipitate CHF in vulnerable individuals, and that they have applied the same message to selective COX-2 inhibitors.