Cyclooxygenase-2 selectivity of non-steroidal anti-inflammatory drugs and the risk of myocardial infarction and cerebrovascular accident
Cyclooxygenase-2 selectivity of non-steroidal anti-inflammatory drugs and the risk of myocardial infarction and cerebrovascular accident
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DOI：
10.1111/j.1365-2036.2007.03292.x
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发表时间：
2007-04-15
影响因子：
7.6
通讯作者：
Deswal, A.
中科院分区：
文献类型：
--
作者：
Abraham, N. S.;El-Serag, H. B.;Deswal, A.
目的评估非甾体抗炎药（NSAID）对环氧化酶-2（考克斯-2）的选择性程度与心肌梗死（MI）或脑血管意外（CVA）的风险。按照考克斯-2选择性对NSAID进行分类。使用Cox比例风险模型评估首次处方后180天内CVA和MI的发生率，该模型根据性别、种族、心血管和药理学风险因素以及高选择性考克斯-2 NSAID处方倾向进行调整。结果在384322例患者中（97.5%为男性，85.4%为白色），79.4%的患者处方了选择性较差的NSAID，16.4%的患者处方了选择性中等的NSAID，4.2%的患者处方了选择性较高的NSAID。在> 145870人年中有985例MI和586例CVA。高选择性药物的MI（12.3/1000人-年; [95% CI：12.2-12.3]）和CVA（8.1/1000人-年; [95% CI：8.0-8.2]）发生率最高。没有NSAID暴露的时期与最低风险相关。在调整后的模型中，高度选择性考克斯-2选择性NSAID与CVA增加61%和MI增加47%，相比，选择性差的NSAIDs.Conclusions MI和CVA的风险增加与任何NSAID。高度考克斯-2选择性NSAID的风险最大。
Aim To assess degree of cyclooxygenase-2 (COX-2) selectivity of a non-steroidal anti-inflammatory drug (NSAID) and risk of myocardial infarction (MI) or cerebrovascular accident (CVA).Methods Prescription fill data were linked to medical records of a merged VA-Medicare dataset. NSAIDs were categorized by Cox-2 selectivity. Incidence of CVA and MI within 180 days of index prescription was assessed using Cox-proportional hazards models adjusted for gender, race, cardiovascular and pharmacological risk factors and propensity for prescription of highly COX-2 selective NSAIDs. Results Of 384 322 patients (97.5% men and 85.4% white), 79.4% were prescribed a poorly selective, 16.4% a moderately selective and 4.2% a highly selective NSAID. There were 985 incident cases of MI and 586 cases of CVA in > 145 870 person-years. Highly selective agents had the highest rate of MI (12.3 per 1000 person-years; [95% CI: 12.2-12.3]) and CVA (8.1 per 1000 person-years; [95% CI: 8.0-8.2]). Periods without NSAID exposure were associated with lowest risk. In adjusted models, highly selective COX-2 selective NSAIDs were associated with a 61% increase in CVA and a 47% increase in MI, when compared with poorly selective NSAIDs.Conclusions The risk of MI and CVA increases with any NSAID. Highly COX-2 selective NSAIDs confer the greatest risk.