Rahme Elham, Pilote Louise, LeLorier Jacques
Division of Clinical Epidemiology, Montreal General Hospital, 1650 Cedar Ave, Room L10-408, Montreal, Quebec, Canada H3G 1A4.
Arch Intern Med. 2002 May 27;162(10):1111-5. doi: 10.1001/archinte.162.10.1111.
The association between the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and acute myocardial infarction (AMI) is unclear. Nonsteroidal anti-inflammatory drugs vary in their antithrombotic properties, with naproxen having a particularly effective antithrombotic potential.
To compare the effect of naproxen vs other NSAIDs in the prevention of AMI in an older population.
Population-based, matched case-control study. Patients (aged > or =65 years) in Quebec had been hospitalized for AMI between January 1, 1992, and December 31, 1994. The admission date for AMI was considered the index date. Control subjects were randomly selected from a Quebec drug and physician claims database. For each case, a control was matched with the same index date, age (within 2 years), and sex. Cases and controls were required to have at least 1 year of pharmaceutical and medical records before the index date to identify risk factors for AMI and exposure to naproxen or other nonaspirin NSAIDs. Concurrent exposure to a medication was defined as exposure to that medication at the index date. Logistic regression analyses were used to evaluate the association between the use of naproxen and other NSAIDs in the prevention of AMI, adjusting for potential confounders.
Included in the study were 4163 cases and 14 160 controls. Determinants (adjusted odds ratios [95% confidence intervals]) of AMI included use in the prior year of anticoagulants (0.76 [0.64-0.90]), nitrates (2.01 [1.86-2.17]), antidiabetic agents (1.72 [1.56-1.90]), antihypertensive agents (1.36 [1.28-1.45]), and lipid-lowering agents (0.83 [0.75-0.91]), as well as concurrent exposure to naproxen vs other NSAIDs (0.79 [0.63-0.99]).
Compared with other NSAIDs, concurrent exposure to naproxen has a protective effect against AMI.
非甾体抗炎药（NSAIDs）的使用与急性心肌梗死（AMI）之间的关联尚不清楚。非甾体抗炎药的抗血栓特性各不相同，其中萘普生具有特别有效的抗血栓潜力。
比较萘普生与其他非甾体抗炎药在老年人群中预防急性心肌梗死的效果。
基于人群的配对病例对照研究。1992年1月1日至1994年12月31日期间，魁北克省年龄≥65岁因急性心肌梗死住院的患者纳入研究。急性心肌梗死的入院日期被视为索引日期。对照对象从魁北克省药品和医生索赔数据库中随机选取。为每个病例匹配一名索引日期、年龄（相差2岁以内）和性别相同的对照。病例和对照在索引日期前至少有1年的药物和医疗记录，以确定急性心肌梗死的危险因素以及萘普生或其他非阿司匹林非甾体抗炎药的暴露情况。同时使用某种药物定义为在索引日期使用该药物。采用逻辑回归分析评估萘普生和其他非甾体抗炎药的使用与预防急性心肌梗死之间的关联，并对潜在混杂因素进行校正。
研究纳入4163例病例和14160例对照。急性心肌梗死的决定因素（调整后的比值比[95%置信区间]）包括前一年使用抗凝剂（0.76[0.64 - 0.90]）、硝酸盐（2.01[1.86 - 2.17]）、抗糖尿病药物（1.72[1.56 - 1.90]）、抗高血压药物（1.36[1.28 - 1.45]）和降脂药物（松0.83[0.75 - 0.91]），以及同时使用萘普生与其他非甾体抗炎药（0.79[0.63 - 0.99]）。
与其他非甾体抗炎药相比，同时使用萘普生对急性心肌梗死具有保护作用。
