Comparative cardiovascular safety of nonsteroidal anti‐inflammatory drugs in patients with hypertension: a population‐based cohort study

Aims Previous studies have suggested that nonsteroidal anti‐inflammatory drugs (NSAIDs) may be associated with higher cardiovascular risks. However, few have been active comparison studies that directly assessed the potential differential cardiovascular risk between NSAID classes or across individua...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:British journal of clinical pharmacology 2018-05, Vol.84 (5), p.1045-1056
Hauptverfasser: Dong, Yaa‐Hui, Chang, Chia‐Hsuin, Wu, Li‐Chiu, Hwang, Jing‐Shiang, Toh, Sengwee
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
Beschreibung
Zusammenfassung:Aims Previous studies have suggested that nonsteroidal anti‐inflammatory drugs (NSAIDs) may be associated with higher cardiovascular risks. However, few have been active comparison studies that directly assessed the potential differential cardiovascular risk between NSAID classes or across individual NSAIDs. We compared the risk of major cardiovascular events between cyclooxygenase 2 (COX‐2)‐selective and nonselective NSAIDs in patients with hypertension. Methods We conducted a cohort study of patients with hypertension who initiated COX‐2‐selective or nonselective NSAIDs in a population‐based Taiwanese database. The outcomes included hospitalization for the following major cardiovascular events: ischaemic stroke, acute myocardial infarction, congestive heart failure, transient ischaemic attack, unstable angina or coronary revascularization. We followed patients for up to 4 weeks, based on the as‐treated principle. We used inverse probability weighting to control for baseline and time‐varying covariates, and estimated the on‐treatment hazard ratios (HRs) and 95% conservative confidence interval (CIs). Results We identified 2749 eligible COX‐2‐selective NSAID users and 52 880 eligible nonselective NSAID users. The HR of major cardiovascular events comparing COX‐2‐selective with nonselective NSAIDs after adjusting for baseline and time‐varying covariates was 1.07 (95% CI 0.65, 1.74). We did not observe a differential risk when comparing celecoxib to diclofenac (HR 1.17; 95% CI 0.61, 2.25), ibuprofen (HR 1.36; 95% CI 0.58, 3.18) or naproxen (HR 0.75; 95% CI 0.23, 2.44). There was an increased risk with COX‐2‐selective NSAIDs, however, when comparing COX‐2‐selective NSAIDs with mefenamic acid (HR 2.11; 95% CI 1.09, 4.09). Conclusions Our results provide important information about the comparative cardiovascular safety of NSAIDs in patients with hypertension.
ISSN:0306-5251
1365-2125
DOI:10.1111/bcp.13537