Subgroup analyses to determine cardiovascular risk associated with nonsteroidal antiinflammatory drugs and coxibs in specific patient groups
Open Access
- 30 July 2008
- journal article
- therapeutics
- Published by Wiley in Arthritis Care & Research
- Vol. 59 (8), 1097-1104
- https://doi.org/10.1002/art.23911
Abstract
Objective To explore the extent to which clinical characteristics influence the association between cyclooxygenase 2 inhibitors (coxibs) and/or nonselective nonsteroidal antiinflammatory drugs (NSAIDs) and increased cardiovascular disease (CVD) risk in specific patient subgroups. There is substantial concern regarding the potential cardiovascular adverse effects of selective coxibs and nonselective NSAIDs, but many patients with arthritis experience important clinical benefits from these agents. Methods The study population consisted of Medicare beneficiaries also eligible for a drug benefits program for older adults during the years 1999–2004. We calculated the relative risk (RR) for CVD events (myocardial infarction [MI], stroke, congestive heart failure, and cardiovascular death) among users of coxibs or nonselective NSAIDs in the prior 6 months compared with nonusers. We assessed biologic interaction between these medication exposures and important patient characteristics. Results In the primary cohort, we identified 76,082 new users of coxibs, 53,014 new users of nonselective NSAIDs, and 46,558 nonusers. Compared with nonusers, the adjusted RR of CVD events for new users of each agent increased for rofecoxib (RR 1.22, 95% confidence interval [95% CI] 1.14, 1.30) and decreased for naproxen (RR 0.79, 95% CI 0.67, 0.93). Several patient characteristics were found to increase the risk of CVD events among users of some agents in both the primary and secondary cohorts, including age ≥80 years, hypertension, prior MI, prior CVD, rheumatoid arthritis, chronic renal disease, and chronic obstructive pulmonary disease. Rofecoxib and ibuprofen appeared to confer an increased risk in multiple patient subgroups. Conclusion Many nonselective NSAIDs and coxibs are not associated with an increased risk of CVD events. However, several patient characteristics identify important subgroups that may be at an increased risk when using specific agents.This publication has 22 references indexed in Scilit:
- Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trialsBMJ, 2006
- Biological basis for the cardiovascular consequences of COX-2 inhibition: therapeutic challenges and opportunitiesJCI Insight, 2005
- Calculating measures of biological interactionEuropean Journal of Epidemiology, 2005
- Cardiovascular Events Associated with Rofecoxib in a Colorectal Adenoma Chemoprevention TrialThe New England Journal of Medicine, 2005
- Cardiovascular Risk Associated with Celecoxib in a Clinical Trial for Colorectal Adenoma PreventionThe New England Journal of Medicine, 2005
- Complications of the COX-2 Inhibitors Parecoxib and Valdecoxib after Cardiac SurgeryThe New England Journal of Medicine, 2005
- Accuracy of medicare claims-based diagnosis of acute myocardial infarction: estimating positive predictive value on the basis of review of hospital recordsAmerican Heart Journal, 2004
- Confidence Intervals for Measures of InteractionEpidemiology, 1996
- Presentation adapting a clinical comorbidity index for use with ICD-9-CM administrative data: Differing perspectivesJournal of Clinical Epidemiology, 1993
- No Adjustments Are Needed for Multiple ComparisonsEpidemiology, 1990