Meta-Analysis: Cardiovascular Events Associated with Nonsteroidal Anti-inflammatory Drugs - 17/08/11
, Peter Gregor, MD b, Thomas M. Ormiston, MD b, Richard Whitlock, MD c, Parminder Raina, PhD c, d, Lehana Thabane, PhD d, e, Eric J. Topol, MD f
Requests for reprints should be addressed to Shelly R. Salpeter, MD, Santa Clara Valley Medical Center, 751 S. Bascom Ave, San Jose, CA 95128Abstract |
Purpose |
We performed a meta-analysis of randomized controlled trials to assess the effect of nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) on cardiovascular events in trials of joint disease and Alzheimer’s disease.
Methods |
We performed comprehensive searches of MEDLINE, EMBASE, CINAHL and Cochrane databases from 1966 to July 2005, and references of identified articles and reviews. We included randomized placebo-controlled trials of at least 6 weeks duration that evaluated nonselective NSAIDs in trials of joint disease or Alzheimer’s disease, and reported at least one cardiovascular event or death. The outcome measured was the composite of death, myocardial infarction or cerebrovascular accident, with the pooled results reported as odds ratios (OR). Subgroup analyses evaluated the difference between trials of joint disease and Alzheimer’s disease, and for naproxen and non-naproxen NSAIDs.
Results |
Pooled data from 13 trials with 7718 participants showed that nonselective NSAIDs had no significant effect on cardiovascular events (OR 1.3; 95% confidence interval [CI], 0.8 to 2.1). No significant effect was seen for joint disease trials (OR 0.6; 95% CI, 0.2 to 1.7) or Alzheimer disease trials (OR 1.6; 95% CI, 0.9 to 2.7). There was no significant difference in results for naproxen and non-naproxen NSAIDs.
Conclusion |
Nonselective NSAIDs have no significant effect on cardiovascular events or death in trials of joint disease and Alzheimer disease, but a small adverse effect could not be excluded. An indication for risk was present in trials of Alzheimer’s disease but not in joint disease trials. There was no significant adverse or cardioprotective effect of naproxen.
Le texte complet de cet article est disponible en PDF.Keywords : Non-steroidal anti-inflammatory agents, Cyclooxygenase-2 inhibitors, Cardiovascular disease, Meta-analysis
Plan
| None of the authors have any relationships with a manufacturer of NSAIDs or COX-2 inhibitors at present. Parminder Raina has held a grant from Merck Frost Canada in the past. Shelley Salpeter served as a consultant for Wyeth and was paid on an hourly basis. Peter Gregor served on the speaker’s bureau for Dupont before 2002. |
Vol 119 - N° 7
P. 552-559 - juillet 2006 Retour au numéro
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