Harmful Effects of NSAIDs among Patients with Hypertension and Coronary Artery Disease
Harmful Effects of NSAIDs among Patients with Hypertension and Coronary Artery Disease
复制标题
DOI：
10.1016/j.amjmed.2011.02.025
复制
发表时间：
2011-07-01
影响因子：
5.9
通讯作者：
Pepine, Carl J.
中科院分区：
文献类型：
--
作者：
Bavry, Anthony A.;Khaliq, Asma;Pepine, Carl J.
背景技术背景：关于慢性非甾体类抗炎药（NSAID）在高血压合并冠心病患者中的安全性的信息有限：这是一项来自国际VErapamil群多普利研究（INVEST）的事后分析，该研究招募了高血压和冠心病患者。每次访视时，当地研究中心研究者询问患者目前是否正在服用NSAID。在每次访视时报告使用NSAID的患者定义为慢性NSAID使用者，而所有其他患者（偶尔或从不使用者）定义为非慢性NSAID使用者。主要复合终点为全因死亡、非致死性心肌梗死或非致死性卒中。考克斯回归被用来构建一个多变量分析的主要outcome.RESULTS：有882慢性NSAID用户和21,694非慢性NSAID用户（n = 14,408从未用户和n = 7286间歇用户）。在平均随访2.7年时，慢性NSAID组的主要结局发生率为4.4例事件/100患者年，而非慢性NSAID组为3.7例事件/100患者年（校正风险比[HR] 1.47; 95%置信区间[CI]，1.19-1.82; P = .0003）。这是由于心血管死亡率的增加（校正HR 2.26; 95%CI，1.70-3.01; P < .0001）。结论：在高血压合并冠状动脉疾病患者中，长期自我报告使用NSAID与长期随访期间不良事件风险增加相关。(C)2011 Elsevier Inc. All rights reserved.美国医学杂志（2011）124，614-620
BACKGROUND: There is limited information about the safety of chronic nonsteroidal anti-inflammatory drugs (NSAIDs) in hypertensive patients with coronary artery disease.METHODS: This was a post hoc analysis from the INternational VErapamil Trandolapril STudy (INVEST), which enrolled patients with hypertension and coronary artery disease. At each visit, patients were asked by the local site investigator if they were currently taking NSAIDs. Patients who reported NSAID use at every visit were defined as chronic NSAID users, while all others (occasional or never users) were defined as nonchronic NSAID users. The primary composite outcome was all-cause death, nonfatal myocardial infarction, or nonfatal stroke. Cox regression was used to construct a multivariate analysis for the primary outcome.RESULTS: There were 882 chronic NSAID users and 21,694 nonchronic NSAID users (n = 14,408 for never users and n = 7286 for intermittent users). At a mean follow-up of 2.7 years, the primary outcome occurred at a rate of 4.4 events per 100 patient-years in the chronic NSAID group, versus 3.7 events per 100 patient-years in the nonchronic NSAID group (adjusted hazard ratio [HR] 1.47; 95% confidence interval [CI], 1.19-1.82; P = .0003). This was due to an increase in cardiovascular mortality (adjusted HR 2.26; 95% CI, 1.70-3.01; P < .0001).CONCLUSION: Among hypertensive patients with coronary artery disease, chronic self-reported use of NSAIDs was associated with an increased risk of adverse events during long-term follow-up. (C) 2011 Elsevier Inc. All rights reserved. The American Journal of Medicine (2011) 124, 614-620