Risk of acute myocardial infarction and sudden cardiac death in patients treated with cyclo-oxygenase 2 selective and non-selective non-steroidal anti-inflammatory drugs: nested case-control study
Risk of acute myocardial infarction and sudden cardiac death in patients treated with cyclo-oxygenase 2 selective and non-selective non-steroidal anti-inflammatory drugs: nested case-control study
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DOI：
10.1016/s0140-6736(05)17864-7
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发表时间：
2005-02-05
期刊：
影响因子：
168.9
通讯作者：
Graham, D
中科院分区：
文献类型：
--
作者：
Graham, DJ;Campen, D;Graham, D
大剂量罗非昔布增加还是那普利降低严重冠心病风险的问题一直存在争议。由于塞来昔布是罗非昔布最常见的替代品，我们试图确定与远程非甾体抗炎药（NSAID）使用或塞来昔布使用相比，高剂量或标准剂量的罗非昔布是否会增加风险，方法我们使用来自加州Kaiser Permanente的数据，收集1999年1月1日至12月31日期间年龄18-84岁接受NSAID治疗的所有患者的队列。2001年，我们做了一个嵌套的病例对照研究。严重冠心病（急性心肌梗死和心源性猝死）病例与年龄、性别和健康计划地区的4个对照组进行风险集匹配。目前暴露于环氧合酶2选择性和非选择性非甾体抗炎药进行了比较，远程暴露于任何非甾体抗炎药，罗非昔布与celecoxib.Findings相比，在2 302 029人年的后续行动，8143例严重冠心病发生，其中2210（27.1%）是致命的。与塞来昔布相比，多变量校正比值比为：罗非昔布（所有剂量），1.59（95% CI 1.10-2.32，p=0.015）;罗非昔布25 mg/天或更少，1.47（0.99-2.17，p=0.054）;罗非昔布大于25 mg/天，3.58（1.27-10.11，p=0.016）。对于萘普生与非甾体抗炎药的使用，调整后的比值比为1.14（1.00-1.30，p=0.05）。解释与塞来昔布相比，罗非昔布的使用增加了严重冠心病的风险。使用萘普生不能预防严重的冠心病。
Background Controversy has surrounded the question about whether high-dose rofecoxib increases or naproxen decreases the risk of serious coronary heart disease. We sought to establish if risk was enhanced with rofecoxib at either high or standard doses compared with remote non-steroidal anti-inflammatory drug (NSAID) use or celecoxib use, because celecoxib was the most common alternative to rofecoxib.Methods We used data from Kaiser Permanente in California to assemble a cohort of all patients age 18-84 years treated with a NSAID between Jan 1, 1999, and Dec 31, 2001, within which we did a nested case-control study. Cases of serious coronary heart disease (acute myocardial infarction and sudden cardiac death) were risk-set matched with four controls for age, sex, and health plan region. Current exposure to cyclo-oxygenase 2 selective and non-selective NSAIDs was compared with remote exposure to any NSAID, and rofecoxib was compared with celecoxib.Findings During 2 302 029 person-years of follow-up, 8143 cases of serious coronary heart disease occurred, of which 2210 (27.1%) were fatal. Multivariate adjusted odds ratios versus celecoxib were: for rofecoxib (all doses), 1.59 (95% CI 1.10-2.32, p=0.015); for rofecoxib 25 mg/day or less, 1.47 (0.99-2.17, p=0.054); and for rofecoxib greater than 25 mg/day, 3.58 (1.27-10.11, p=0.016). For naproxen versus remote NSAID use the adjusted odds ratio was 1.14 (1.00-1.30, p=0.05).Interpretation Rofecoxib use increases the risk of serious coronary heart disease compared with celecoxib use. Naproxen use does not protect against serious coronary heart disease.