Ray Wayne A, Stein C Michael, Hall Kathi, Daugherty James R, Griffin Marie R
Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
Lancet. 2002 Jan 12;359(9301):118-23. doi: 10.1016/S0140-6736(02)07370-1.
Non-aspirin, non-steroidal anti-inflammatory drugs (NANSAIDs) have complex effects that could either prevent or promote coronary heart disease. Comparison of the NANSAID rofexocib with naproxen showed a substantial difference in acute myocardial infarction risk, which has been interpreted as a protective effect of naproxen. We did an observational study to measure the effects of NANSAIDs, including naproxen, on risk of serious coronary heart disease.
We used data from the Tennessee Medicaid programme obtained between Jan 1, 1987, and Dec 31, 1998, to identify a cohort of new NANSAID users (n=181 441) and an equal number of non-users, matched for age, sex, and date NANSAID use began. Both groups were 50-84 years of age, were not resident in a nursing home, and did not have life-threatening illness. The study endpoint was hospital admission for acute myocardial infarction or death from coronary heart disease.
During 532634 person-years of follow-up, 6362 cases of serious coronary heart disease occurred, or 11.9 per 1000 person-years. Multivariate-adjusted rate ratios for current and former use of NANSAIDs were 1.05 (95% CI 0.97-1.14) and 1.02 (0.97-1.08), respectively. Rate ratios for naproxen, ibuprofen, and other NANSAIDs were 0.95 (0.82-1.09), 1.15 (1.02-1.28), and 1.03 (0.92-1.16), respectively. There was no protection among long-term NANSAID users with uninterrupted use; the rate ratio among current users with more than 60 days of continuous use was 1.05 (0.91-1.21). When naproxen was directly compared with ibuprofen, the current-use rate ratio was 0.83 (0.69-0.98).
Absence of a protective effect of naproxen or other NANSAIDs on risk of coronary heart disease suggests that these drugs should not be used for cardioprotection.
非阿司匹林类非甾体抗炎药（NANSAIDs）具有复杂的作用，既可能预防也可能促进冠心病。罗非昔布与萘普生的比较显示急性心肌梗死风险存在显著差异，这被解释为萘普生具有保护作用。我们进行了一项观察性研究，以评估包括萘普生在内的NANSAIDs对严重冠心病风险的影响。
我们使用了1987年1月1日至1998年12月31日期间从田纳西医疗补助计划获得的数据，确定了一组新的NANSAIDs使用者队列（n = 181441）以及数量相等的非使用者，根据年龄、性别和开始使用NANSAIDs的日期进行匹配。两组年龄均在50 - 84岁之间，不住在养老院，且没有危及生命的疾病。研究终点为因急性心肌梗死住院或死于冠心病。
在532634人年的随访期间，发生了6362例严重冠心病病例，即每1000人年11.9例。当前和既往使用NANSAIDs的多变量调整率比分别为1.05（95%可信区间0.97 - 1.14）和1.02（0.97 - 1.08）。萘普生、布洛芬和其他NANSAIDs的率比分别为0.95（0.82 - 1.09）、1.15（1.02 - 1.28）和1.03（0.92 - 1.16）。长期不间断使用NANSAIDs的人群中没有保护作用；连续使用超过60天的当前使用者的率比为1.05（0.91 - 1.21）。当直接比较萘普生和布洛芬时，当前使用的率比为0.83（0.69 - 0.98）。
萘普生或其他NANSAIDs对冠心病风险缺乏保护作用表明，这些药物不应被用于心脏保护。
