The connection between acute coronary syndrome and the use of anti-inflammatory drugs was positive and significant
Keywords:
Anti-Inflammatory Agents, Cross-Over Studies, Non-Steroidal Acute Coronary SyndromeAbstract
Aims: Evaluate cardiovascular impact related to the use of non steroidal anti-inflammatory drugs in a Health Area, by estimating the connection between the previous medical prescription of non steroidal anti-inflammatory medicines and acute coronary syndrome.
Material and Methods: A retrospective observational study of clinical casecrosover during 5 years is done, from 1st of January 2008 to 31st of December 2012. In first place patients were cases and controls (n=1.317) who suffered cardiovascular accidents and went to Emergency Room. Setting: Alcazar de San Juan Health Care Area. Main measurements: Association of the risk of acute coronary syndrome by Odds Ratio with consumption of non anti-inflammatory drug.
Results: The connection between acute coronary syndrome and the use of anti-inflammatory drugs was positive and significant (OR 1.42; IC95% 1.06-1.9), which means the probability of suffering a cardiovascular accident increases to 42% in patients taking non steroidal anti-inflammatory drugs. The connection between the prescription of anti-inflammatory drugs and acute coronary syndrome reached a bigger magnitude in patients with less comorbidity, Charlson ≤ 1 (OR 1.66; IC95% 1.15 – 2.40) as opposite to those with more comorbidity, Charlson > 1 (OR 1.07; IC95% 0.65 – 1.76). This change of effect was due, in part, to the concomitant use of medicines which prevent cardiovascular diseases, such as antiaggregant, anticoagulant and statins drugs.
Conclusions: The use of non steroidal anti-inflammatory drugs has been connected to a higher risk of cardiovascular accidents; therefore it is necessary to realize follow-up patients who consume these drugs. These drugs must not be consumed for a long time or at high doses.
Downloads
References
Day MD, Morrison B, Luza A, Castaneda O, Strusberg A, Nahir M et al. Arandomised trial of the efficacy and tolerability of the COX-2 inhibitor rofecoxib vs ibuprofen in patients with osteoarthritis. Arch Intern Med 2000;160: 1781-87.
Utilización de medicamentos antiinflamatorios no esteroideos (AINE) en España durante el período 2000-2012. Informe de utilización de medicamentos U/AIN/15012014 [citado 31 de enero de 2014]. Disponible en: http://wwwaemps.gob.es
Chen LC, Ashcroft DM. Risk of myocardial infarction associated with selective COX-2 inhibitors: meta-analysis of randomised controlled trials. Pharmacoepidemiol Drug Saf. 2007 Jul;16(7):762-72.
Trelle S, Reichenbach S, Wandel S, Hildebrand P, Tschannen B, Villiger PM, Egger M, Jüni P. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ. 2011 Jan 11; 342:c7086.
Bhala N, Emberson J, Merhi A y cols. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013. 382(9894) 769-79
Varas-Lorenzo C, Riera-Guardia N, Calingaert B, Castellsague J, Pariente A, Scottil L, Stukernboom M and Perez-Gutthann S. Stroke Risk and Nonsteroidal Anti-inflammatory Drugs. A Systematic Review of Observational Studies. Pharmacoepidemiol Drug Saf. 2011 Dec;20(12):1225-36.
McGettigan P, Henry D Cardiovascular risk and inhibition of cyclooxygenase: a systematic review of the observational studies of selective and nonselective inhibitors of cyclooxygenase 2. JAMA. 2006 Oct 4; 296(13):1633-44.
McGettigan P, Henry D. Cardiovascular risk with non-steroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies. PLoS Med. 2011 Sep; 8(9):e1001098.
Valderas JM, Mendivil J, Parada A, Losada-Yáñez M, Alonso J. Development of a geographic filter for PubMed to identify studies performed in Spain. Rev Esp Cardiol. 2006; 59(12):1244-51.
García Rodríguez LA, González-Pérez A, Bueno H, Hwa J. NSAID use selectively increases the risk of non-fatal myocardial infarction: a systematic review of randomised trials and observational studies. PLoS One. 2011; 6(2):e16780.
Varas-Lorenzo C, Castellsague J, Stang MR, Perez-Gutthann S, Aguado J, Rodriguez LA. The use of selective cyclooxygenase-2 inhibitors and the risk of acute myocardial infarction in Saskatchewan, Canada. Pharmacoepidemiol Drug Saf. 2009 Nov;18(11):1016-25.
García Rodríguez LA, Tacconelli S, Patrignani P. Role of dose potency in the prediction of risk of myocardial infarction associated with nonsteroidal anti-inflammatory drugs in the general population. J Am Coll Cardiol. 2008 Nov 11;52(20):1628-36.
García Rodríguez LA, Egan K, FitzGerald GA. Traditional nonsteroidal anti-inflammatory drugs and postmenopausal hormone therapy: a drug-drug interaction? PLoS Med. 2007; 4(5):e157
García Rodríguez LA, González-Pérez A. Long-term use of non-steroidal antiinflammatory drugs and the risk of myocardial infarction in the general population. BMC Med. 2005; 29;3:17.
García Rodríguez LA, Varas-Lorenzo C, Maguire A, González-Pérez A. Nonsteroidal antiinflammatory drugs and the risk of myocardial infarction in the general population. Circulation. 2004 Jun 22;109(24):3000-6.
García Rodríguez LA. The effect of NSAIDs on the risk of coronary heart disease: fusion of clinical pharmacology and pharmacoepidemiologic data. Clin Exp Rheumatol. 2001 Nov-Dec;19(6 Suppl 25):S41-4.
García Rodríguez LA, Varas C, Patrono C. Differential effects of aspirin and non-aspirin nonsteroidal antiinflammatory drugs in the primary prevention of myocardial infarction in postmenopausal women. Epidemiology. 2000 Jul;11(4):382-7.
Maclure M. The case-crossover design: a method for studying transient effects on the risk of acute events. Am J Epidemiol 1991 Jan 15;133(2):144-53.
Instituto Nacional de Estadística. Cifras de población [ citado 10 de enero 2013 ]. Disponible en: http://www.ine.es/inebmenu//mnu_cifraspob.htm
Kearney, Patricia M, Baigent, Colin, Godwin, Jon, Halls, Heather, Emberson, Jonathan R et al. Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. British Medical Journal. 2006; 332 (7553); 1302-8.
MHRA Public Assessment Report Non-steroidal anti-inflammatory drugs and cardiovascular risks in the general population Plain language summary.
Hamm C. W, Bassand J-P, Agewall S, Bax J, Boersma E, Bueno H et al. Guía de práctica clínica de la ESC para el manejo del síndrome coronario agudo en pacientes sin elevación persistente del segmento ST. Artículo especial. Revista Española Cardiología 2012; 65(2):173.e1-e55
Schjerning Olsen, Anne-Marie, Fosbøl, Emil L, Lindhardsen, Jesper, Folke, Fredrik Charlot, Mette et al. Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction in patients with prior myocardial infarction: a nationwide cohort study. Circulation. 2011; 123 (20): 2226-35.
Bresalier, Robert S, Sandler, Robert S, Quan, Hui, Bolognese, James a, Oxenius, Bettina, Horgan, Kevin et al. Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. The New England journal of medicine. 2005; 352 (11): 1092-102.
Bombardier C, Laine L, Ricin A, Shapiro D, Burgos-Vargas R, Davis B, et al. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. N Eng J Med 2000; 343: 1520-28.
Lennernas H, Fager G. Pharmacodinamics and pharmacokinetics of the HMG-COA reductase inhibitors: similataries and differencies. Clin Pharmacokinet 1997; 32: 403-425.
Gislason, Gunnar H, Jacobsen, Søren, Rasmussen, Jeppe N, Rasmussen, Søren Buch, Pernille, Friberg, Jens. Risk of death or reinfarction associated with the use of selective cyclooxygenase-2 inhibitors and nonselective nonsteroidal antiinflammatory drugs after acute myocardial infarction. Circulation. 2006; 113. 2906-13.
Downloads
Published
How to Cite
Issue
Section
License
The articles, which are published in this journal, are subject to the following terms in relation to the rights of patrimonial or exploitation:
- The authors will keep their copyright and guarantee to the journal the right of first publication of their work, which will be distributed with a Creative Commons BY-NC-SA 4.0 license that allows third parties to reuse the work whenever its author, quote the original source and do not make commercial use of it.
b. The authors may adopt other non-exclusive licensing agreements for the distribution of the published version of the work (e.g., deposit it in an institutional telematic file or publish it in a monographic volume) provided that the original source of its publication is indicated.
c. Authors are allowed and advised to disseminate their work through the Internet (e.g. in institutional repositories or on their website) before and during the submission process, which can produce interesting exchanges and increase citations of the published work. (See The effect of open access).
