NSAID Use and Association with Cardiovascular Outcomes in Outpatients with Stable Atherothrombotic Disease - 31/12/13
on behalf of the
REACH Registry Investigators1
Abstract |
Background |
Nonsteroidal anti-inflammatory drugs (NSAIDs) other than aspirin have been linked to heart failure, salt retention, adverse ventricular remodeling, and thrombosis. We therefore sought to assess their impact on cardiovascular events in outpatients with stable atherothrombotic disease.
Methods |
We analyzed 44,095 patients in the REduction of Atherothrombosis for Continued Health (REACH) registry with information on NSAID use and 4-year follow-up. Cox proportional hazard models, including NSAID use as a time-dependent covariate, were constructed and adjusted for key baseline characteristics. End points of interest included multivariate adjusted: cardiovascular death/myocardial infarction/stroke/ischemic hospitalizations; cardiovascular death/myocardial infarction/stroke; hospitalization for heart failure; and individual components of the composite end points.
Results |
Compared with NSAID nonusers (n = 39,675), NSAID users (n = 4420) were older (70 vs 68 years), more frequently female and white, and had more baseline heart failure and atherosclerotic risk factors (hypertension, dyslipidemia, diabetes, reduced creatinine clearance) (all P < .001). NSAID use was associated with an increased hazard for cardiovascular death/myocardial infarction/stroke/ischemic hospitalizations (adjusted hazard ratio [adj. HR] 1.12; 95% confidence interval [CI], 1.04-1.21; P = .003) and for cardiovascular death/myocardial infarction/stroke (adj. HR 1.16; 95% CI, 1.03-1.30; P = .02). There also was a higher risk of myocardial infarction (adj. HR 1.37; 95% CI, 1.12-1.68; P = .002), stroke (adj. HR 1.21; 95% CI, 1.00-1.45; P = .048), heart failure hospitalizations (adj. HR 1.18; 95% CI, 1.03-1.34; P = .013), and ischemic hospitalizations (adj. HR 1.17; 95% CI, 1.07-1.27; P = .001).
Conclusion |
Among patients with stable atherothrombosis, NSAID use is associated with a higher risk of myocardial infarction, stroke, and hospitalizations for both ischemia and heart failure.
Le texte complet de cet article est disponible en PDF.Keywords : Heart failure, NSAID, Outcomes, Stable atherothrombosis
Plan
| Funding: The REduction of Atherothrombosis for Continued Health (REACH) study was sponsored by Sanofi Aventis, Bristol-Myers Squibb, and the Waksman Foundation and is endorsed by the World Heart Federation. |
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| Conflict of Interest: PK discloses consulting fees from Daiichi-Sankyo. GS discloses the following relationships: Research grant (to INSERM U698): NYU School of Medicine, Sanofi, Servier; Speaking or consulting: Amarin, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, GlaxoSmithKline, Lilly, Medtronic, Otsuka, Pfizer, Roche, sanofi, Servier, The Medicines Company, Vivus; Stockholding: Aterovax. CPC discloses research grants/support from the following companies: Accumetrics, AstraZeneca, CSL Behring, Essentialis, GlaxoSmithKline, Merck, Regeneron, Sanofi, Takeda, Advisory Board (with funds donated to charity): Alnylam, Bristol-Myers Squibb, Lipimedix, Pfizer; Clinical Advisor, with equity in Automedics Medical Systems. MJA discloses participation on the U.S. Steering Committee for the REduction of Atherothrombosis for Continued Health (REACH) registry and the Global and U.S. Publications committee for REACH in addition to reimbursement for travel and participation on the above committees by Bristol-Myers Squibb and Sanofi-Aventis. ES has nothing to disclose. SG discloses the following relationships: Advisory Board: CareNet; Co-Chair: The SSC Subcommittee on Predictive Variables in Cardiovascular Disease; Honoraria: TIMI group (clinical trial steering committees), Duke Clinical Research Institute (clinical trial steering committees), Life Science Publications (Medical Editor, Antithromtotic Therapy Trial Database); Other: Associate Editor, Thrombosis and Haemostasis, Journal of Atherosclerosis and Thrombosis, Archives of Medical Science; Research Grants: Sanofi-Aventis, Boehringer-Ingelheim, Otsuka, Daiichi-Sankyo. SCS has nothing to disclose. KAE has nothing to disclose. EMO discloses the following: Research grants from Daiichi Sankyo, Eli Lilly, Gilead Sciences; consulting fees from Astra Zeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Janssen Pharmaceuticals, Liposcience, Merck, Pozen, Roche, Sanofi Aventis, The Medicines Company, WebMD; Speakers Bureau from Boehringer Ingelheim, Janssen Pharmaceuticals, Liposcience; DLB discloses the following relationships: Advisory Board: Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Chest Pain Centers; Chair: American Heart Association Get With The Guidelines Steering Committee; Honoraria: American College of Cardiology (Editor, Clinical Trials, Cardiosource), Duke Clinical Research Institute (clinical trial steering committees), Slack Publications (Chief Medical Editor, Cardiology Today Intervention), WebMD (CME steering committees); Other: Senior Associate Editor, Journal of Invasive Cardiology; Research Grants: Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Medtronic, Sanofi Aventis, The Medicines Company; Unfunded Research: FlowCo, PLx Pharma, Takeda. |
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| Authorship: All authors listed had full access to the data in this study and participated in the writing and critical revision of this manuscript. |
Vol 127 - N° 1
P. 53 - janvier 2014 Retour au numéro
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