Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, the Netherlands.
PHARMO Institute, Utrecht, The Netherlands.
PLoS One. 2018 Nov 1;13(11):e0204746. doi: 10.1371/journal.pone.0204746. eCollection 2018.
Use of selective COX-2 non-steroidal anti-inflammatory drugs (NSAIDs) (coxibs) has been associated with an increased risk of acute myocardial infarction (AMI). However, the risk of AMI has only been studied for very few NSAIDs that are frequently used.
To estimate the risk of AMI for individual NSAIDs.
A nested case-control study was performed from a cohort of new NSAID users ≥18 years (1999-2011) matching cases to a maximum of 100 controls on database, sex, age, and calendar time. Data were retrieved from six healthcare databases. Adjusted odds ratios (ORs) of current use of individual NSAIDs compared to past use were estimated per database. Pooling was done by two-stage pooling using a random effects model (ORmeta) and by one-stage pooling (ORpool).
Among 8.5 million new NSAID users, 79,553 AMI cases were identified. The risk was elevated for current use of ketorolac (ORmeta 2.06;95%CI 1.83-2.32, ORpool 1.80; 1.49-2.18) followed, in descending order of point estimate, by indometacin, etoricoxib, rofecoxib, diclofenac, fixed combination of diclofenac with misoprostol, piroxicam, ibuprofen, naproxen, celecoxib, meloxicam, nimesulide and ketoprofen (ORmeta 1.12; 1.03-1.22, ORpool 1.00;0.86-1.16). Higher doses showed higher risk estimates than lower doses.
The relative risk estimates of AMI differed slightly between 28 individual NSAIDs. The relative risk was highest for ketorolac and was correlated with COX-2 potency, but not restricted to coxibs.
使用选择性环氧化酶-2 非甾体抗炎药（NSAIDs）（昔布类）与急性心肌梗死（AMI）的风险增加有关。然而，只有少数经常使用的 NSAIDs 进行了 AMI 风险的研究。
估计个体 NSAIDs 发生 AMI 的风险。
从 1999 年至 2011 年新 NSAID 使用者队列中进行了一项嵌套病例对照研究，通过数据库、性别、年龄和日历时间将病例与最多 100 名对照匹配。从六个医疗保健数据库中检索数据。根据每个数据库，估计当前使用与过去使用的个体 NSAIDs 的调整比值比（OR）。使用两阶段随机效应模型（ORmeta）和单阶段汇总（ORpool）进行汇总。
在 850 万新 NSAID 使用者中，确定了 79553 例 AMI 病例。当前使用酮咯酸（ORmeta 2.06；95%CI 1.83-2.32，ORpool 1.80；1.49-2.18）的风险增加，其次是吲哚美辛、依托考昔、罗非昔布、双氯芬酸、双氯芬酸与米索前列醇的固定组合、吡罗昔康、布洛芬、萘普生、塞来昔布、美洛昔康、尼美舒利和酮洛芬（ORmeta 1.12；1.03-1.22，ORpool 1.00；0.86-1.16）。较高剂量的风险估计值高于较低剂量。
28 种个体 NSAIDs 之间的 AMI 相对风险估计值略有不同。酮咯酸的相对风险最高，与 COX-2 效力相关，但不限于昔布类药物。
