Comparative cardiovascular safety of nonsteroidal anti-inflammatory drugs in patients with hypertension: a population-based cohort study
Journal
British Journal of Clinical Pharmacology
Journal Volume
84
Journal Issue
5
Pages
1045-1056
Date Issued
2018
Author(s)
Abstract
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. ? 2018 The British Pharmacological Society
SDGs
Other Subjects
acetylsalicylic acid; celecoxib; diclofenac; ibuprofen; mefenamic acid; naproxen; celecoxib; cyclooxygenase 2 inhibitor; diclofenac; ibuprofen; mefenamic acid; naproxen; nonsteroid antiinflammatory agent; acute heart infarction; adult; aged; Article; brain hemorrhage; brain ischemia; cardiovascular risk; cerebrovascular disease; cohort analysis; congestive heart failure; diabetes mellitus; drug exposure; drug safety; female; heart arrhythmia; heart infarction; heart muscle revascularization; human; hypertension; ischemic heart disease; low drug dose; major adverse cardiac event; major clinical study; male; middle aged; peripheral vascular disease; pharmacoepidemiology; population research; priority journal; Taiwanese; transient ischemic attack; unstable angina pectoris; cardiovascular system; comparative study; drug database; drug effect; hospitalization; hypertension; risk factor; statistics and numerical data; Aged; Anti-Inflammatory Agents, Non-Steroidal; Cardiovascular System; Celecoxib; Cyclooxygenase 2 Inhibitors; Databases, Pharmaceutical; Diclofenac; Female; Hospitalization; Humans; Hypertension; Ibuprofen; Male; Mefenamic Acid; Middle Aged; Naproxen; Risk Factors
Publisher
Blackwell Publishing Ltd
Type
journal article