cardiovascular risk with non-steroidal anti-inflammatory drugs systematic review of population-based controlled observational studies心血管风险与非甾体抗炎药的系统性评价以人群为基础的控制的观察性研究.pdfVIP

Cardiovascular Risk with Non-Steroidal Anti- Inflammatory Drugs: Systematic Review of Population- Based Controlled Observational Studies 1 2,3,4 Patricia McGettigan , David Henry * 1 Hull York Medical School, Hull, United Kingdom, 2 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, 3 Department of Medicine, University of Toronto, Toronto, Ontario, Canada, 4 Discipline of Clinical Pharmacology, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia Abstract Background: Randomised trials have highlighted the cardiovascular risks of non-steroidal anti-inflammatory drugs (NSAIDs) in high doses and sometimes atypical settings. Here, we provide estimates of the comparative risks with individual NSAIDs at typical doses in community settings. Methods and Findings: We performed a systematic review of community-based controlled observational studies. We conducted comprehensive literature searches, extracted adjusted relative risk (RR) estimates, and pooled the estimates for major cardiovascular events associated with use of individual NSAIDs, in different doses, and in populations with low and high background risks of cardiovascular events. We also compared individual drugs in pair-wise (within study) analyses, generating ratios of RRs (RRRs). Thirty case-control studies included 184,946 cardiovascular events, and 21 cohort studies described outcomes in .2.7 million exposed individuals. Of the extensively studied drugs (ten or more studies), the highest overall risks were seen with rofecoxib, 1.45 (95% CI 1.33, 1.59), and diclofenac, 1.40 (1.27, 1.55), and the lowest with ibuprofen, 1.18 (1.11, 1.25), and naproxen, 1.09 (1.02, 1.16). In a sub-set of studies, risk was elevated with low doses of rofecoxi