Schjerning Olsen Anne-Marie, Fosbøl Emil L, Gislason Gunnar H
Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
Basic Clin Pharmacol Toxicol. 2014 Aug;115(2):179-84. doi: 10.1111/bcpt.12244. Epub 2014 Apr 25.
This MiniReview describes the present evidence for the relationship between cardiovascular risk and use of non-steroidal anti-inflammatory drugs (NSAIDs) with special focus using Danish register-based data. NSAIDs are among the most widely used drugs worldwide and mainly used for management of pain and inflammatory conditions. Through the past decade, much attention has been given to the cardiovascular safety of these drugs, and several studies have shown increased risk of adverse cardiovascular effects associated with NSAID use. Current guidelines discourage any use of NSAIDs in patients with cardiovascular disease, yet over a period of 8-10 years, 35-44% of patients with myocardial infarction or heart failure were exposed to NSAIDs in Denmark. Furthermore, NSAID use was associated with an increased risk of death or myocardial infarction by up to 5 times that of non-users. There was also a clear indication for a dose-related response in risk associated with NSAID therapy, supporting a causal association. Notably, the cardiovascular risk associated with NSAID treatment was prevalent at start of treatment, suggesting no safe treatment window for NSAIDs in patients with cardiovascular disease. Thus, evidence from observational studies is accumulating, suggesting that NSAIDs are a major public health concern due to the widespread use of these drugs. Although it seems unlikely that we can completely avoid use of NSAIDs, even among high-risk patients, these results highlight the importance of balancing the benefit versus the risk of treatment before initiating NSAID treatment.
本综述描述了心血管风险与非甾体抗炎药（NSAIDs）使用之间关系的现有证据，特别关注基于丹麦登记数据的研究。NSAIDs是全球使用最广泛的药物之一，主要用于治疗疼痛和炎症性疾病。在过去十年中，这些药物的心血管安全性受到了广泛关注，多项研究表明，使用NSAIDs会增加不良心血管事件的风险。目前的指南不鼓励心血管疾病患者使用任何NSAIDs，但在丹麦，8至10年间，35%至44%的心肌梗死或心力衰竭患者曾使用过NSAIDs。此外，使用NSAIDs的患者死亡或心肌梗死风险比未使用者高出多达5倍。NSAID治疗风险与剂量相关反应的迹象也很明显，支持因果关系。值得注意的是，NSAID治疗相关的心血管风险在治疗开始时就已存在，这表明心血管疾病患者使用NSAIDs不存在安全治疗窗。因此，观察性研究的证据不断积累，表明由于这些药物的广泛使用，NSAIDs是一个重大的公共卫生问题。尽管我们似乎不太可能完全避免使用NSAIDs，即使在高危患者中也是如此，但这些结果凸显了在开始NSAID治疗之前权衡治疗益处与风险的重要性。
