Wan Eric Yuk Fai, Yu Esther Yee Tak, Chan Linda, Mok Anna Hoi Ying, Wang Yuan, Chan Esther Wai Yin, Wong Ian Chi Kei, Lam Cindy Lo Kuen
Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong, China.
Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Ap Lei Chau, Hong Kong, China.
J Clin Pharmacol. 2023 Jan;63(1):126-134. doi: 10.1002/jcph.2142. Epub 2022 Sep 15.
Through examining the incidence of cardiovascular diseases (CVDs) among nonsteroidal anti-inflammatory drug (NSAID) users and nonusers, this study aims to compare the risks contributed by different NSAIDs in a Chinese population. The retrospective cohort including 4 298 368 adults without CVD from electronic health records between 2008 and 2017 in Hong Kong was adopted. A total of 4.5% of individuals received NSAIDs including celecoxib, etoricoxib, diclofenac, ibuprofen, indomethacin, mefenamic acid, or naproxen for ≥4 consecutive weeks at baseline. Cox regression, including NSAID use as a time-dependent covariate and adjusted with patient's characteristics, was conducted to examine the association between NSAID exposure and incident CVD. After a median follow-up of 6.9 years (30 million person-years), a total of 258 601 cases of incident CVD was recorded. NSAID use was shown to be associated with a significantly higher risk of CVD (hazard ratio [HR], 1.32 [95%CI, 1.28-1.37]) compared to non-NSAID use. Similar results in coronary heart disease (HR, 1.37 [95%CI, 1.31-1.43]), stroke (HR, 1.27 [95%CI, 1.21-1.33]), and heart failure (HR, 1.25 [95%CI, 1.16-1.34]) were obtained. Overall, similar CVD risk was observed across users of NSAIDs except for etoricoxib, which showed a higher risk (HR, 2.01 [95%CI, 1.63-2.48]). Considering that a higher CVD risk was consistently displayed among NSAID users, NSAIDs should be used cautiously, and the usage of etoricoxib in the Chinese population should be reviewed.
通过检查非甾体抗炎药（NSAID）使用者和非使用者中心血管疾病（CVD）的发病率，本研究旨在比较不同NSAID在中国人群中造成的风险。采用回顾性队列研究，纳入了2008年至2017年香港电子健康记录中4298368名无CVD的成年人。共有4.5%的个体在基线时连续≥4周使用了包括塞来昔布、依托考昔、双氯芬酸、布洛芬、吲哚美辛、甲芬那酸或萘普生在内的NSAID。进行Cox回归分析，将NSAID使用作为时间依存性协变量，并根据患者特征进行调整，以检查NSAID暴露与新发CVD之间的关联。经过中位随访6.9年（3000万人年），共记录了258601例新发CVD病例。与未使用NSAID相比，使用NSAID与CVD风险显著升高相关（风险比[HR]，1.32[95%CI，1.28 - 1.37]）。在冠心病（HR，1.37[95%CI，1.31 - 1.43]）、中风（HR，1.27[95%CI，1.21 - 1.33]）和心力衰竭（HR，1.25[95%CI，1.16 - 1.34]）方面也得到了类似结果。总体而言，除依托考昔显示出较高风险（HR，2.01[95%CI，1.63 - 2.48]）外，NSAID使用者之间观察到相似的CVD风险。鉴于NSAID使用者中始终显示出较高的CVD风险，应谨慎使用NSAID，并且应重新审视中国人群中依托考昔的使用情况。
