The objective was to measure the impact of
exposure to coxibs and non-steroidal antiinflammatory
drugs (NSAID) on morbidity and
mortality in older patients with acute myocardial
infarction (AMI). A nested case-control
study was carried out using an exhaustive
population-based cohort of patients aged 66
years and older living in Quebec (Canada)
who survived a hospitalization for AMI (ICD-9 410) between 1999 and 2002. The main variables
were all-cause and cardiovascular (CV)
death, subsequent hospital admission for AMI,
and a composite end-point including recurrent
AMI or CV death. Conditional logistic regressions
were used to estimate the risk of mortality
and morbidity. A total of 19,823 patients
aged 66 years and older survived hospitalization
for AMI in the province of Quebec
between 1999 and 2002. After controlling for
covariables, the risk of subsequent AMI and
the risk of composite end-point were
increased by the use of rofecoxib. The risk of
subsequent AMI was particularly high for new
rofecoxib users (HR 2.47, 95% CI 1.57-3.89).
No increased risk was observed for celecoxib
users. No increased risk of CV death was
observed for patients exposed to coxibs or
NSAIDs. Patients newly exposed to NSAIDs
were at an increased risk of death (HR 2.22,
95% CI 1.30-3.77) and of composite end-point
(HR 2.28, 95% CI 1.35-3.84). Users of rofecoxib
and NSAIDs, but not celecoxib, were at an
increased risk of recurrent AMI and of composite
end-point. Surprisingly, no increased
risk of CV death was observed. Further studies
are needed to better understand these apparently
contradictory results.
Cyclooxygenase-2, non-steroidal antiinflammatory drugs, cardiovascular mortality, acute myocardial infarction.
Alain Vanasse, Department of Family Medicine, Faculty of Medicine, Université de Sherbrooke 3001 12th Avenue North, Sherbrooke (Quebec) J1H 5N4, Canada. E-mail: Alain.Vanasse@USherbrooke.ca
This project was subsidized by
the Network of Centers of Excellence GEOIDE.
The principal investigator was also supported by
the Department of Family Medicine, Université
de Sherbrooke, the Clinical Research Centre,
Sherbrooke University Hospital; and the Fonds de
Recherche en Santé du Québec.
2009-08-13T00:00:00
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