Heerdink E R, Leufkens H G, Herings R M, Ottervanger J P, Stricker B H, Bakker A
Department of Pharmacoepidemiology and Pharmacotherapy, University of Utrecht, The Netherlands.
Arch Intern Med. 1998 May 25;158(10):1108-12. doi: 10.1001/archinte.158.10.1108.
Both diuretics and nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used, in particular among the elderly. The use of NSAIDs may decrease the efficacy of diuretics and induce congestive heart failure (CHF) in patients treated with diuretics.
To investigate the risk of CHF associated with combined use of diuretics and NSAIDs in patients older than 55 years.
We conducted a study in a base cohort of 10,519 recipients of diuretics and NSAIDs identified in the PHARMO database during the period from 1986 through 1992. The incidence density of hospitalizations for CHF during exposure to both diuretics and NSAIDs (index) was compared with that during exposure to diuretics only (reference).
We found an overall increased risk of hospitalization for CHF during periods of concomitant use of diuretics and NSAIDs compared with use of diuretics only (crude relative risk, 2.2; 95% confidence interval, 1.7-2.9). After adjusting for cofactors including age, sex, history of hospitalization, and drug use, a 2-fold increased risk remained (relative risk, 1.8; 95% confidence interval, 1.4-2.4).
Use of NSAIDs in elderly patients taking diuretics is associated with a 2-fold increased risk of hospitalization for CHF, especially in those with existing serious CHF.
利尿剂和非甾体抗炎药（NSAIDs）均被广泛使用，尤其是在老年人中。NSAIDs的使用可能会降低利尿剂的疗效，并在接受利尿剂治疗的患者中诱发充血性心力衰竭（CHF）。
调查55岁以上患者联合使用利尿剂和NSAIDs与CHF相关的风险。
我们在1986年至1992年期间从PHARMO数据库中确定的10519名接受利尿剂和NSAIDs治疗的患者的基础队列中进行了一项研究。将同时暴露于利尿剂和NSAIDs（指数）期间CHF住院的发病密度与仅暴露于利尿剂期间（对照）进行比较。
我们发现，与仅使用利尿剂相比，同时使用利尿剂和NSAIDs期间CHF住院的总体风险增加（粗相对风险，2.2；95%置信区间，1.7-2.9）。在对包括年龄、性别、住院史和药物使用等协变量进行调整后，风险仍增加了2倍（相对风险，1.8；95%置信区间，1.4-2.4）。
在服用利尿剂的老年患者中使用NSAIDs与CHF住院风险增加2倍相关，尤其是在已有严重CHF的患者中。
