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Circulation：NSAIDs的服药时间对曾患心梗患者疾病复发的影响

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这个帖子发布于9年零260天前，其中的信息可能已发生改变或有所发展。

摘要翻译：

Background— Despite the fact that nonsteroidal anti-inflammatory drugs (NSAIDs)are contraindicated among patients with established cardiovasculardisease, many receive NSAID treatment for a short period oftime. However, little is known about the association betweenNSAID treatment duration and risk of cardiovascular disease.We therefore studied the duration of NSAID treatment and cardiovascularrisk in a nationwide cohort of patients with prior myocardialinfarction (MI).

^{尽管非甾体类抗炎药在一些患有心血管疾病的患者里是禁忌征，但此类药物仍然经常作为短期治疗而被处方。然而，非甾体类抗炎药治疗时间与心血管疾病患病风险二者之间的联系仍不清楚。为此，我们的研究小组对曾患心梗的患者进行了全国范围的前瞻队列研究，以便研究非甾体类抗炎药的服药时间与心血管疾病患病风险之间的关系。}

Methods and Results— Patients over 30 years of age who were admitted with first-time MIduring 1997 to 2006 and their subsequent NSAID use were identifiedby individual-level linkage of nationwide registries of hospitalizationand drug dispensing from pharmacies in Denmark. Risk of deathand recurrent MI according to duration of NSAID treatment wasanalyzed by multivariable time-stratified Cox proportional-hazardmodels and by incidence rates per 1000 person-years. Of the83 677 patients included, 42.3% received NSAIDs during follow-up.There were 35 257 deaths/recurrent MIs. Overall, NSAID treatmentwas significantly associated with an increased risk of death/recurrentMI (hazard ratio, 1.45; 95% confidence interval, 1.29 to 1.62)at the beginning of the treatment, and the risk persisted throughoutthe treatment course (hazard ratio, 1.55; 95% confidence interval,1.46 to 1.64 after 90 days). Analyses of individual NSAIDs showedthat the traditional NSAID diclofenac was associated with thehighest risk (hazard ratio, 3.26; 95% confidence interval, 2.57to 3.86 for death/MI at day 1 to 7 of treatment).

^{我们选取年龄超过30岁的患者以心梗为第一诊断在1997年到2006年期间收入院的病例，这些患者后续使用非甾体类抗炎药的情况由丹麦全国住院及药物分发医药局的个人服药剂量记录获取。非甾体类抗炎药相关的死亡及心梗复发风险通过多变量时间分层Cox比例风险模型和每1000人年的发生率计算获得。在83677名收录病人里，42.3%在随访期间接受了非甾体类抗炎药治疗.其中共发生了35257例死亡/复发病例。总体说来，非甾体类抗炎药与死亡/复发风险的上升在治疗的起始阶段显著相关（危险比1.45，95%置信区间为1.29到1.62），而且这种风险一直持续整个治疗过程（服药90日后危险比1.55，95%置信区间为1.46到1.64）.从非甾体类抗炎药中分别进行研究，发现传统的非甾体类抗炎药双氯芬酸对此风险贡献最大（治疗的1到7日危险比为3.26，95%置信区间为2。57到3.86）。}

Conclusions— Even short-term treatment with most NSAIDs was associated withincreased risk of death and recurrent MI in patients with priorMI. Neither short- nor long-term treatment with NSAIDs is advisedin this population, and any NSAID use should be limited froma cardiovascular safety point of view.

结论：即使是短期应用，非甾体类抗炎药依然可以显著提高有心梗病史患者的死亡与复发风险。对于这个人群，无论长期或短期的非甾体类抗炎药治疗都不作推荐，如何处方都必须从心血管安全的角度考虑加以限制。