Nonsteroidal anti-inflammatory drug use and acute myocardial infarction
Nonsteroidal anti-inflammatory drug use and acute myocardial infarction
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DOI：
10.1001/archinte.162.10.1099
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发表时间：
2002-05-27
影响因子：
--
通讯作者：
Avorn, J
中科院分区：
文献类型：
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作者：
Solomon, DH;Glynn, RJ;Avorn, J
背景：虽然阿司匹林已被证明可以保护患者免受急性心肌梗死 (AMI) 的影响，但非阿司匹林类非甾体抗炎药 (NSAID) 的作用尚不清楚。 目的： 确定 NSAID 对 AMI 风险是否具有相似的作用或是否有不同的作用。 方法： 我们在一个大型医疗保健数据库中进行了 AMI 病例对照研究，该数据库包含新计划涵盖的所有患者的所有处方、住院、诊断和程序信息。泽西岛老年人和残疾人医疗补助或医疗保险和药物援助计划。我们确定了 1991 年 1 月 1 日至 1995 年 12 月 31 日期间因 AMI 住院的 4425 名患者以及 17 700 名对照受试者。构建多变量模型来控制潜在的混杂因素。结果：四分之一的病例和对照在 AMI（病例）或随机指定的索引日期（对照）之前 6 个月内服用过 NSAID 处方； 9% 的人服用的 NSAID 处方与其 AMI 日期或索引日期重叠。总体而言，NSAID 使用者与非使用者具有相同的 AMI 风险，无论这种使用是在指数日期（调整后优势比，1.04；95% 置信区间，0.92-1.18；P=.55）还是在前 6 个月内的任何时间（调整后优势比，1.00；95% 置信区间，0.92-1.08；P=.92）进行测量的。然而，使用萘普生可显着降低 AMI 风险（调整后比值比，0.84；95% 置信区间，0.72-0.98；P=.03）。 结论：虽然 NSAID 具有与阿司匹林相似的抗炎和抗血小板作用，但我们没有发现这些药物对 AMI 具有保护作用。然而，使用一种特定的 NSAID（萘普生）似乎与 AMI 发生率降低有关，最近一项大型随机对照试验也表明了这一效果。
Background: Although aspirin has been shown to protect patients from acute myocardial infarction (AMI), the effect of nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) is not clear.Objective: To determine whether NSAIDs have a similar effect or whether they differ in their effect on the risk of AMI.Methods: We performed a case-control study of AMI in a large health care database containing information on all filled prescriptions, hospitalizations, diagnoses, and procedures for all patients covered by the New Jersey Medicaid or Medicare and Pharmaceutical Assistance for the Aged and Disabled programs. We identified 4425 patients hospitalized for AMI between January 1, 1991, and December 31, 1995, and 17 700 control subjects. Multivariate models were constructed to control for potential confounders.Results: A quarter of the cases and controls had filled a prescription for an NSAID in the 6 months before their AMI (cases) or a randomly assigned index date (controls); 9% had filled a prescription for an NSAID that overlapped with their date of AMI or index date. Overall, NSAID users had the same risk of AMI as nonusers, whether such use was measured on the index date (adjusted odds ratio, 1.04; 95% confidence interval, 0.92-1.18; P=.55) or at any time in the prior 6 months (adjusted odds ratio, 1.00; 95% confidence interval, 0.92-1.08; P=.92). However, use of naproxen was associated with a significant reduction in the risk of AMI (adjusted odds ratio, 0.84; 95% confidence interval, 0.72-0.98; P=.03).Conclusions: Although NSAIDs have anti-inflammatory and antiplatelet effects similar to those of aspirin, we did not find that these drugs confer a protective effect against AMI. However, use of one specific NSAID, naproxen, appeared to be associated with a reduced rate of AMI, an effect recently suggested by a large randomized controlled trial as well.