van Staa T-P, Rietbrock S, Setakis E, Leufkens H G M
General Practice Research Database, Medicines and Healthcare Products Regulatory Agency, London, UK.
J Intern Med. 2008 Nov;264(5):481-92. doi: 10.1111/j.1365-2796.2008.01991.x. Epub 2008 Jun 25.
To investigate the risk of myocardial infarction (MI) with diclofenac, ibuprofen and naproxen, taking into account the exposure patterns.
Retrospective cohort study using the General Practice Research Database. Setting. UK primary care. Subjects. Patients aged 40+ years prescribed a traditional nonsteroidal anti-inflammatory drug (NSAID). The control cohort was frequency matched by disease risk score.
Observational comparisons of MI rates.
The study included 729,294 NSAID users and 443,047 controls. The relative rate (RR) for MI increased with cumulative and daily dose (RR = 1.05 with 0-4 prior prescriptions and RR = 1.49 with 30+; RR = 1.05 with daily dose of < 1200 mg ibuprofen and RR = 1.96 with dose of > or = 2400 mg per day; for diclofenac, the RR was 1.13 with < 150 mg per day and 2.03 with > or = 300 mg per day). Diclofenac users had higher risks of MI (RR = 1.21) than ibuprofen (RR = 1.04) or naproxen (RR = 1.03) users, but exposure varied between these drugs. Taking into account these exposure differences, it was found that the risk of MI was comparable in current and past long-term users. The patterns of hazard rates (i.e. absolute risks) of MI were similar in patients using ibuprofen, diclofenac or naproxen with similar history of NSAID use. There was no statistical difference between ibuprofen, diclofenac and ibuprofen in the linear trends for cumulative dose or daily dose.
Long-term users of traditional NSAIDs have an increased risk of MI that is probably explained by the underlying disease severity. Most of the differences in MI risk between diclofenac, ibuprofen or naproxen may be explained by their varied use.
考虑到用药模式，研究双氯芬酸、布洛芬和萘普生导致心肌梗死（MI）的风险。
使用全科医疗研究数据库进行回顾性队列研究。地点：英国初级医疗保健机构。研究对象：年龄在40岁及以上且开具了传统非甾体抗炎药（NSAID）的患者。对照组按疾病风险评分进行频率匹配。
对心肌梗死发生率进行观察性比较。
该研究纳入了729,294名非甾体抗炎药使用者和443,047名对照者。心肌梗死的相对发生率（RR）随累积剂量和每日剂量增加而升高（既往处方0 - 4次时RR = 1.05，30次及以上时RR = 1.49；布洛芬每日剂量< 1200 mg时RR = 1.05，每日剂量≥2400 mg时RR = 1.96；双氯芬酸每日剂量< 150 mg时RR = 1.13，每日剂量≥300 mg时RR = 2.03）。双氯芬酸使用者发生心肌梗死的风险（RR = 1.21）高于布洛芬使用者（RR = 1.04）和萘普生使用者（RR = 1.03），但这些药物的用药情况各不相同。考虑到这些用药差异，发现当前和既往长期使用者发生心肌梗死的风险相当。在使用布洛芬、双氯芬酸或萘普生且非甾体抗炎药使用史相似的患者中，心肌梗死的风险率模式（即绝对风险）相似。布洛芬、双氯芬酸和萘普生在累积剂量或每日剂量的线性趋势方面无统计学差异。
传统非甾体抗炎药的长期使用者发生心肌梗死的风险增加，这可能是由潜在疾病的严重程度所致。双氯芬酸、布洛芬或萘普生之间心肌梗死风险的大多数差异可能是由它们不同的用药情况所解释。
