Document Detail

Harmful effects of NSAIDs among patients with hypertension and coronary artery disease.
MedLine Citation:
PMID:  21596367     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: There is limited information about the safety of chronic nonsteroidal anti-inflammatory drugs (NSAIDs) in hypertensive patients with coronary artery disease.
METHODS: This was a post hoc analysis from the INternational VErapamil Trandolapril STudy (INVEST), which enrolled patients with hypertension and coronary artery disease. At each visit, patients were asked by the local site investigator if they were currently taking NSAIDs. Patients who reported NSAID use at every visit were defined as chronic NSAID users, while all others (occasional or never users) were defined as nonchronic NSAID users. The primary composite outcome was all-cause death, nonfatal myocardial infarction, or nonfatal stroke. Cox regression was used to construct a multivariate analysis for the primary outcome.
RESULTS: There were 882 chronic NSAID users and 21,694 nonchronic NSAID users (n = 14,408 for never users and n=7286 for intermittent users). At a mean follow-up of 2.7 years, the primary outcome occurred at a rate of 4.4 events per 100 patient-years in the chronic NSAID group, versus 3.7 events per 100 patient-years in the nonchronic NSAID group (adjusted hazard ratio [HR] 1.47; 95% confidence interval [CI], 1.19-1.82; P=.0003). This was due to an increase in cardiovascular mortality (adjusted HR 2.26; 95% CI, 1.70-3.01; P<.0001).
CONCLUSION: Among hypertensive patients with coronary artery disease, chronic self-reported use of NSAIDs was associated with an increased risk of adverse events during long-term follow-up.
Anthony A Bavry; Asma Khaliq; Yan Gong; Eileen M Handberg; Rhonda M Cooper-Dehoff; Carl J Pepine
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-05-18
Journal Detail:
Title:  The American journal of medicine     Volume:  124     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-06-20     Completed Date:  2011-08-11     Revised Date:  2012-05-07    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  614-20     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Department of Medicine, College of Medicine, University of Florida, Gainesville, 32610-0277, USA.
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MeSH Terms
Anti-Inflammatory Agents, Non-Steroidal / administration & dosage,  adverse effects*
Antihypertensive Agents / therapeutic use*
Blood Pressure / drug effects
Confounding Factors (Epidemiology)
Coronary Artery Disease / complications*,  drug therapy
Diclofenac / adverse effects
Drug Administration Schedule
Follow-Up Studies
Hypertension / complications*,  drug therapy*
Ibuprofen / adverse effects
Indoles / therapeutic use
Kaplan-Meier Estimate
Middle Aged
Multicenter Studies as Topic
Multivariate Analysis
Myocardial Infarction / chemically induced,  epidemiology*,  etiology,  mortality
Naproxen / adverse effects
Odds Ratio
Proportional Hazards Models
Pyrazoles / adverse effects
Randomized Controlled Trials as Topic
Stroke / chemically induced,  epidemiology*,  etiology,  mortality
Sulfonamides / adverse effects
Verapamil / therapeutic use
Reg. No./Substance:
0/Anti-Inflammatory Agents, Non-Steroidal; 0/Antihypertensive Agents; 0/Indoles; 0/Pyrazoles; 0/Sulfonamides; 15307-86-5/Diclofenac; 15687-27-1/Ibuprofen; 169590-42-5/celecoxib; 22204-53-1/Naproxen; 52-53-9/Verapamil; 87679-37-6/trandolapril
Comment In:
Internist (Berl). 2012 Apr;53(4):488, 490   [PMID:  22410944 ]
Am J Med. 2012 Feb;125(2):e9; author reply e11   [PMID:  22269634 ]

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