Hudson Marie, Baron Murray, Rahme Elham, Pilote Louise
Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada.
J Rheumatol. 2005 Aug;32(8):1589-93.
To determine whether patients taking aspirin for secondary prevention of myocardial infarction are at increased risk of recurrent disease when they take concomitant ibuprofen.
In this population based, retrospective cohort study using governmental databases, patients > or = 66 years of age, hospitalized for an index acute myocardial infarction (AMI) between January 1992 and March 1999 and taking ASA throughout the period of followup were identified. The main exposure was the concomitant use of ibuprofen and ASA after the index AMI. The outcome of interest was recurrent AMI. Subjects were followed to one year after the index AMI.
A total of 18,503 patients met the study entry criteria. Of these, 372 patients were dispensed a prescription for ibuprofen (exposed) and 14,424 patients were not dispensed a prescription for any nonsteroidal antiinflammatory drug (NSAID) (unexposed). Patients dispensed prescriptions for any NSAID (n = 4079), naproxen (n = 1239), and diclofenac (n = 1474) were analyzed separately. There was a trend to an increase in the rate of recurrent AMI in patients taking ibuprofen and ASA compared to those taking ASA alone as the duration of exposure increased [hazard ratios for ever, > or = 30 days, and > or = 60 days exposed were 1.01 (95% CI 0.58-1.76), 1.13 (95% CI 0.54-2.39), and 1.83 (95% CI 0.76-4.42), respectively]. In contrast, subjects taking prolonged naproxen and ASA had a trend toward a lower rate of recurrent AMI compared to those taking ASA alone.
The results are consistent with data that suggest that regular, but not intermittent, ibuprofen may abrogate the benefits of aspirin when used for the secondary prevention of AMI. There may be differences in the risk of heart disease with various NSAID.
确定心肌梗死二级预防中服用阿司匹林的患者同时服用布洛芬时，复发性疾病风险是否增加。
在这项基于人群的回顾性队列研究中，使用政府数据库，确定年龄≥66岁、于1992年1月至1999年3月因首次急性心肌梗死（AMI）住院且在整个随访期间服用阿司匹林的患者。主要暴露因素是首次AMI后同时使用布洛芬和阿司匹林。感兴趣的结局是复发性AMI。对患者随访至首次AMI后一年。
共有18503例患者符合研究纳入标准。其中，372例患者获得了布洛芬处方（暴露组），14424例患者未获得任何非甾体抗炎药（NSAID）处方（非暴露组）。对获得任何NSAID处方（n = 4079）、萘普生处方（n = 1239）和双氯芬酸处方（n = 1474）的患者分别进行分析。与仅服用阿司匹林的患者相比，服用布洛芬和阿司匹林的患者复发性AMI发生率有随暴露时间增加而上升的趋势[暴露时间为曾暴露、≥30天和≥60天的风险比分别为1.01（95%CI 0.58 - 1.76）、1.13（95%CI 0.54 - 2.39）和1.83（95%CI 0.76 - 4.42）]。相比之下，与仅服用阿司匹林的患者相比，长期服用萘普生和阿司匹林的患者复发性AMI发生率有下降趋势。
结果与以下数据一致，即规律而非间歇性服用布洛芬可能会消除阿司匹林用于AMI二级预防的益处。不同NSAID的心脏病风险可能存在差异。
