Fischer Lorenz M, Schlienger Raymond G, Matter Christian M, Jick Hershel, Meier Christoph R
Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacology and Toxicology, University Hospital, Basel, Switzerland.
Pharmacotherapy. 2005 Apr;25(4):503-10. doi: 10.1592/phco.25.4.503.61021.
To evaluate the risk of acute myocardial infarction during current exposure to nonsteroidal antiinflammatory drugs (NSAIDs).
Retrospective case-control analysis.
General practice offices.
A total of 8688 case patients, aged 89 years or younger, with a first-time acute myocardial infarction and 33,923 control subjects matched on age, sex, calendar time, and general practice attended.
The United Kingdom General Practice Research Database was searched for potential cases of first-time acute myocardial infarction between January 1995 and April 2001. Control subjects without acute myocardial infarction were identified at random.
Exposure to NSAIDs was assessed, and 650 case patients and 2339 control subjects were found to be currently taking NSAIDs. After adjusting for various risk factors for acute myocardial infarction (e.g., hypertension, hyperlipidemia, diabetes mellitus, ischemic heart disease, body mass index, smoking), the relative risk (expressed as odds ratio [OR]) of acute myocardial infarction was 1.07 (95% confidence interval [CI] 0.96-1.19) for subjects with current NSAID exposure compared with those not taking NSAIDs. The adjusted OR for current diclofenac use was 1.23 (95% CI 1.00-1.51), for current ibuprofen use 1.16 (95% CI 0.92-1.46), and for current naproxen use 0.96 (95% CI 0.66-1.38) compared with those not taking NSAIDs. Current aspirin use combined with current NSAID use was associated with a statistically significant risk reduction (adjusted OR 0.74, 95% CI 0.57-0.97), compared with nonuse of NSAIDs and aspirin. Current use of aspirin together with current use of ibuprofen yielded an adjusted OR of 0.69 (95% CI 0.42-1.15).
Our results provide additional evidence that the risk of first-time acute myocardial infarction during current use of NSAIDs is not materially altered. We found no evidence for a reduced cardioprotective effect of aspirin with concomitant NSAID use.
评估当前使用非甾体抗炎药（NSAIDs）期间急性心肌梗死的风险。
回顾性病例对照分析。
全科医疗诊所。
共8688例年龄在89岁及以下的首次急性心肌梗死患者，以及33923名在年龄、性别、日历时间和就诊的全科医疗方面相匹配的对照对象。
检索英国全科医疗研究数据库，查找1995年1月至2001年4月期间首次急性心肌梗死的潜在病例。随机确定无急性心肌梗死的对照对象。
评估NSAIDs的使用情况，发现650例病例患者和2339名对照对象正在服用NSAIDs。在对急性心肌梗死的各种危险因素（如高血压、高脂血症、糖尿病、缺血性心脏病、体重指数、吸烟）进行调整后，与未服用NSAIDs的对象相比，当前使用NSAIDs的对象发生急性心肌梗死的相对风险（以比值比[OR]表示）为1.07（95%置信区间[CI] 0.96 - 1.19）。与未服用NSAIDs的对象相比，当前使用双氯芬酸的调整后OR为1.23（95% CI 1.00 - 1.51），当前使用布洛芬的为1.16（95% CI 0.92 - 1.46），当前使用萘普生的为0.96（95% CI 0.66 - 1.38）。与未使用NSAIDs和阿司匹林相比，当前使用阿司匹林并同时使用NSAIDs与统计学上显著的风险降低相关（调整后OR 0.74，95% CI 0.57 - 0.97）。当前同时使用阿司匹林和布洛芬的调整后OR为0.69（95% CI 0.42 - 1.15）。
我们的结果提供了更多证据，表明当前使用NSAIDs期间首次急性心肌梗死的风险没有实质性改变。我们没有发现阿司匹林与NSAIDs同时使用时其心脏保护作用降低的证据。
