Dr Abraham and colleagues from Texas assessed the degree of cyclooxygenase-2 selectivity of non-steroidal anti-inflammatory drugs (NSAIDs) and risk of myocardial infarction or cerebrovascular accident.
The research team linked prescription fill data to medical records of a merged Veterans Affairs-Medicare dataset.
Non-steroidal anti-inflammatory drugs were categorized by cyclooxygenase-2 selectivity.
The researchers assessed incidence of cerebrovascular accident and myocardial infarction within 180 days of index prescription.
|Highly selective agents increased myocardial infarction by 47%|
|Alimentary Pharmacology & Therapeutics|
The team used Cox-proportional hazards models adjusted for gender, race, and cardiovascular and pharmacological risk factors.
The researchers also adjusted for prescription of highly cyclooxygenase-2 selective non-steroidal anti-inflammatory drugs.
The researchers evaluated the prescriptions of 384,322 patients, of which 98% were men and 85% were white.
Of these patients, the team found that 79% had a poorly selective, 16% a moderately selective, and 4% a highly selective non-steroidal anti-inflammatory drug.
There were 985 incident cases of myocardial infarction, and 586 cases of cerebrovascular accident in over 145,870 person-years.
The researchers noted that highly selective agents had the highest rate of myocardial infarction, at 12 per 1000 person-years.
The rate of cerebrovascular accident with highly selective agents was 8 per 1000 person-years.
Periods without non-steroidal anti-inflammatory drug exposure were associated with lowest risk.
Using adjusted models, the team observed that these highly selective agents were associated with a 61% increase in cerebrovascular accident.
Highly vs poorly selective cyclooxygenase-2 selective non-steroidal anti-inflammatory drugs increased myocardial infarction by 47%.
Dr Abraham's team concluded, “The risk of myocardial infarction and cerebrovascular accident increases with any non-steroidal anti-inflammatory drug.”
“Highly cyclooxygenase-2 selective non-steroidal anti-inflammatory drugs confer the greatest risk.”