Cardiovascular risk with non-steroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies.

摘要: Background: Randomised trials have highlighted the cardiovascular risks of non-steroidal anti-inflammatory drugs (NSAIDs) in high doses and sometimes atypical settings. Here, we provide estimates comparative with individual NSAIDs at typical community Methods Findings: We performed a systematic review community-based controlled observational studies. conducted comprehensive literature searches, extracted adjusted relative risk (RR) estimates, pooled for major events associated use NSAIDs, different doses, populations low background events. also compared pair-wise (within study) analyses, generating ratios RRs (RRRs). Thirty case-control studies included 184,946 events, 21 cohort described outcomes .2.7 million exposed individuals. Of extensively studied (ten or more studies), highest overall were seen rofecoxib, 1.45 (95% CI 1.33, 1.59), diclofenac, 1.40 (1.27, 1.55), lowest ibuprofen, 1.18 (1.11, 1.25), naproxen, 1.09 (1.02, 1.16). In sub-set studies, was elevated 1.37 (1.20, 1.57), celecoxib, 1.26 (1.09, 1.47), 1.22 (1.12, 1.33), rose each case higher doses. Ibuprofen only Naproxen risk-neutral all less etoricoxib, 2.05 (1.45, 2.88), etodolac, 1.55 (1.28, 1.87), indomethacin, 1.30 (1.19, 1.41), had risks. comparisons, etoricoxib RR than RRR=1.68 (99% 1.14, 2.49), RRR=1.75 (1.16, 2.64); etodolac not significantly from naproxen ibuprofen. lower RRR=0.92 (0.87, 0.99). constant disease early course treatment. Conclusions: This suggests that among widely used low-dose ibuprofen are least likely to increase risk. Diclofenac available without prescription elevates The data sparse, but comparisons this drug Indomethacin is an older, rather toxic drug, evidence on casts doubt its continued clinical use. Please see later article Editors’ Summary.