Risk of myocardial infarction in patients taking cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs: population based nested case-control analysis

摘要: Aims To determine the comparative risk of myocardial infarction in patients taking cyclo-oxygenase-2 and other non-steroidal anti-inflammatory drugs (NSAIDs) primary care between 2000 2004; to these risks with without pre-existing coronary heart disease those not aspirin. Design Nested case-control study. Setting 367 general practices contributing UK QRESEARCH database spread throughout every strategic health authority board England, Wales, Scotland. Subjects 9218 cases a first ever diagnosis during four year study period; 86 349 controls matched for age, calendar year, sex, practice. Outcome measures Unadjusted adjusted odds ratios 95% confidence intervals associated rofecoxib, celecoxib, naproxen, ibuprofen, diclofenac, selective non-selective NSAIDS. Odds were smoking status, comorbidity, deprivation, use statins, aspirin, antidepressants. Results A significantly increased was current rofecoxib (adjusted ratio 1.32, interval 1.09 1.61) compared no within previous three years; diclofenac (1.55, 1.39 1.72); ibuprofen (1.24, 1.11 1.39). Increased NSAIDs, NSAIDs; significant at < 0.05 rather than 0.01 but tests trend. No interactions occurred any NSAIDs either aspirin or disease. Conclusion These results suggest an despite adjustment many potential confounders. evidence found support reduction naproxen. This is observational may be subject residual confounding that cannot fully corrected for. However, enough concerns exist warrant reconsideration cardiovascular safety all NSAIDs.