非甾体抗炎药的环氧化酶-2选择性与心肌梗死和脑血管意外风险
Cyclooxygenase-2 selectivity of non-steroidal anti-inflammatory drugs and the risk of myocardial infarction and cerebrovascular accident.
作者信息
Abraham N S, El-Serag H B, Hartman C, Richardson P, Deswal A
机构信息
Houston Center for Quality of Care and Utilization Studies, and Deparment of Gastroenterology, Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX 77030, USA.
出版信息
Aliment Pharmacol Ther. 2007 Apr 15;25(8):913-24. doi: 10.1111/j.1365-2036.2007.03292.x.
AIM
To assess degree of cyclooxygenase-2 (COX-2) selectivity of a non-steroidal anti-inflammatory drug (NSAID) and risk of myocardial infarction (MI) or cerebrovascular accident (CVA).
METHODS
Prescription fill data were linked to medical records of a merged VA-Medicare dataset. NSAIDs were categorized by Cox-2 selectivity. Incidence of CVA and MI within 180 days of index prescription was assessed using Cox-proportional hazards models adjusted for gender, race, cardiovascular and pharmacological risk factors and propensity for prescription of highly COX-2 selective NSAIDs.
RESULTS
Of 384,322 patients (97.5% men and 85.4% white), 79.4% were prescribed a poorly selective, 16.4% a moderately selective and 4.2% a highly selective NSAID. There were 985 incident cases of MI and 586 cases of CVA in >145 870 person-years. Highly selective agents had the highest rate of MI (12.3 per 1000 person-years; [95% CI: 12.2-12.3]) and CVA (8.1 per 1000 person-years; [95% CI: 8.0-8.2]). Periods without NSAID exposure were associated with lowest risk. In adjusted models, highly selective COX-2 selective NSAIDs were associated with a 61% increase in CVA and a 47% increase in MI, when compared with poorly selective NSAIDs.
CONCLUSIONS
The risk of MI and CVA increases with any NSAID. Highly COX-2 selective NSAIDs confer the greatest risk.
目的
评估一种非甾体抗炎药（NSAID）的环氧化酶-2（COX-2）选择性程度以及心肌梗死（MI）或脑血管意外（CVA）的风险。
方法
将处方配药数据与合并的退伍军人事务部-医疗保险数据集的医疗记录相链接。NSAIDs根据COX-2选择性进行分类。使用Cox比例风险模型评估索引处方后180天内CVA和MI的发生率，该模型针对性别、种族、心血管和药理学风险因素以及高COX-2选择性NSAIDs的处方倾向进行了调整。
结果
在384,322名患者中（97.5%为男性，85.4%为白人），79.4%的患者被开具了低选择性NSAIDs，16.4%为中等选择性，4.2%为高选择性NSAIDs。在超过145,870人年的时间里，有985例MI和586例CVA事件。高选择性药物的MI发生率最高（每1000人年12.3例；[95%置信区间：12.2 - 12.3]），CVA发生率为（每1000人年8.1例；[95%置信区间：8.0 - 8.2]）。未接触NSAIDs的时间段风险最低。在调整后的模型中，与低选择性NSAIDs相比，高选择性COX-2选择性NSAIDs与CVA增加61%和MI增加47%相关。
结论
任何NSAIDs都会增加MI和CVA的风险。高COX-2选择性NSAIDs的风险最大。
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